SPWGWITH LOT AND HIS CHILDREN: R.ESF,ARCEING ADOLESCENT SEXUALITY IN THE EASTERN CARLBBEAN

by Tamil Rainanne Kendall B.&, University of Ottawa, 1995

Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Arts

in the School of Communication

@Tamil Rainanne Kendall, 2000 SIMON FRASER UNIVERSITY Jaiiuary, 2000

Al1 rights reserved. This work may not be reproduced in whole or part, by photocopy or other means, without permission of the author. National Library Bibliothéque nationale 1*1 of Canada du Canada Acquisitions and Acquisitions et Bibliographie Services services bibliographiques 395 Wellington Street 395, rue WdGngtm OtîawaON KlAW ChtawaON K1AW canada Canada

The author has granted a non- L'auteur a accordé une Licence non exclusive licence allowing the exclusive permettant a la National Library of Canada to Bibliothèque nationale du Canada de reproduce, loan, distribute or seii reproduire, prêter, distribuer ou copies of this thesis in rnicrofonn, vendre des copies de cette thèse sous paper or electronic formats. la forme de microfiche/film, de reproduction sur papier ou sur format électronique.

The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts from it Ni la thèse ni des extraits substantiels may be printed or otheMrise de celle-ci ne doivent être imprimés reproduced without the author' s ou autrement reproduits sans son permission. autorisation. ABSTRACT Based on my experience researching adolescent sexual health on the Eastern Caribbean island of Anguilla, 1 examine how my subject position, and the social relations 1 experienced in the field, contributed to the identification of adolescent sexual and reproductive health as a research area and the selection of a questionnaire for investigating the topic. 1 also consider how the research process influenced the progression fkom research to dissemination to implementation. Do the research choices and working partnerships we make in heterogeneous comrnunities benefit the social groups we airn to assist or work to their detnment by reinforcing existing social relations? Using Stanley Cohen's concept of moral panic, 1 describe how the economic and culturai histoïy of Anguilla redted in a simultaneous race for economic growth and nostalgia for the past as a moral model. In this context, youth were cast as deviant, and adolescent sexuaiity was described as a crisis. Despite a putative scripturally based consensus on sexual morality, analysis of the social context and the survey findings revealed multiple discourses about sexuality and wide discrepancies between the dominant ideals for sexuality and common senial practices. 1 hypothesized the discourse about adolescent sexuality put foward in the atmosphere of moral panic acted as a bamîer to youth achieving optimal health by discouraging discussion of the gap between sexual ideals and common senial practices, thus supporting the status quo. The survey research 1 undertook ailowed me to disrupt the popular characterization of youth as moraliy compt, and argue for increased sexual health education and services rather than a retum to traditional moraiity as a response to adolescent sexual practices. The research dissemination process opened a space for youth and adults to discuss the sexual culture of Anguilla with reduced fear of social censure. However, the primary research method 1 employed replicated the top-down decision-making culture of Anguilla, and the recornrnendations 1 put foward invested upper managers with the responsibility to bring about change. Expecting current decision-makers to challenge the status quo is counterintuitive. The lesson that can be derived from this case study is that social dynamics that support the desired outcomes mua be built into the research process. DEDICATION

The thesis is dedicated to Chantai, for starting me on this joumey. To my mother, Myma, because of your unconditional support and constant encouragement. And to the young Anguillians who showed courage, patience and tenacity and found ways to teil their stones. ACKNOWLEDGEMENTS

1 would iike to thank my cornmittee: Pat Howard for her unfailing diligence and gentle guidance, and Martin Laba. Thanks to Bob Anderson for his continued support and interest, and Andria Scanlan, for her good advice. Sincere appreciation aiso goes to my coUeagues in the School of Communication, and to Stephanie KeUington and Mamie Thorp, for their feedback and Wendship. Findy, endless thanks to d four of my parents for their emotionai and matenal support. TABLE OF CONTENTS .. Approval Page u

S.. Abstract LU Dedication iv Acknowledgements v Table of Contents vi List of Figures vuS..

Introduction: Lot's Children 1 Chapter One: The Rescarch Process 5 Needs Assessrnent 5 Pre-Departure Preparation 5 Interviews and Focus Groups 11 Births to Teenage Mot hers 20 Re-Defining the Problem and the Project 22 Survey Methodology 23 Educational Elites, Developrnent and the Lure of "Science" 25 "An Air Conditioned Office" 28 Self Disclosure 29 A Participatory Survey Instrument 34 Research Goals 37

Chapter Two: A Morai Panic Beyond the Periphery, 1650- 1967 The Anguiiiian Revolution, 1967- 1969 Tourisrn and Economic Growth, 1984- 1999 Growth, Nostalgia and Perception of Risk Christianity and Cable Youth Visibility Sexual Boundary Zones Signification Spiral Conclusion vii

Chapter Three: The Hypothcsis The Exceptions to the Rule The Rules Anguillian Christianity/Scriptural Interpretation soca United Nations Family Planning Association MPHOP Words and Context A View From Below A View From Above Conclusion Chapter Four: The Strategy The Ideals The Realities Addressing the Gaps Between Ideals and Reaiities Sexual and Reproductive Health Education Knowledge of HIVAIDS Knowledge of Fertility and Contraception Educating for Sexual Planning Communication Channels Parents as Sexuality Educators Youth and the Public Health System Logistics of Service Delivery Perceptions of Service Providers Conclusion

Chapter Five: Evaluation Critera One: Validity of the Needs Assessrnent Criteria Two: Fostering Dialogue Creating a Safe Space Re-Defhing the Issues- Deconstructing the Moral Panic Youth in Dialogue Criteria Three: Talk and Action Conclusion

Works Cited

Appendix 1 List of Figures

Figure 1: Births to Teenage Mothers, 1972-1 997...... -. . .- - .--...... - ... -20

Figure 2: Cable Subsaibers, 1993- 1998...... -...... -. . -...... , .. -53 INTRODUCTION: LOT'S CHILDREN Du~g1998 and 1999,I spent eight months on the island of Anguilla conducùng research about adolescent sexual and reproductive health and sharing the findings of the research in public cons~ltations.~There, the biblical story of Lot was mentioned when 1 told people 1 was researching adolescent sexuality or asked questions about semal health (Field Notes, September

5, 1998; September 27, 1998). According to this Old Testament story, Yahweh sent two angels to the city of Sodom to investigate rurnours the Sodomites were not Living according to His law. When they arrived in Sodom, the angels met Lot, who insisted on offering them hospitality. That evening, the Sodomites demonstrated their disobedience to Yahweh's law by corning to Lot's home and demanding to have homosemal relations with his guests. Lot proved his righteousness by refusing the request of the men gathered outside his door. The foiiowing day, the angels rewarded Lot by sending him and his family away before they bumed Sodom and the sister city of Gomorrah to the ground. Anguilla was compared by Anguillians to Sodom and Gomorahh. The story was used to point out the existence of "sexual sin" in Anguilla and to argue that Anguillians who participate in sinfûl sexual activity will be punished, while those who maintain Gods law will be saved. SpeciticaiIy, Anguiliians invoked the story of Lot to suggest deviation fiom God's law through homosexuaiity2 would result in punishment in the form of HIVIAIDS. More broadly, the story was deployed to express the logic that sexual transgression (whether homosexuality, infidelity or sex before mamage) will result in jualy deserved punishment. Interested in Anguillians invocation of the story of Lot, I tumed to the text and found it to be an excellent allegory for factors influencing the sexual and reproductive health of adolescents in Anguilla and, retrospectively, for explaining some of the consequences of my position as a foreign researcher:

'The position was an uitemship fiinded through the Canadian International Development Agency and Human Resources and Development Canada and planned by a Canadian non-governmental organization, Organization for Cooperation in Ooerseas Development, in collaboration wvith the Anguillian Ministry of Social Se~ces. 2Thc term "sodomy' to descrii anal sex is a biblical refcrence to the semai practices in ttie city of Sodom. ...ail the men fiom every part of the city of Sodom-both young and old- surrounded the house. They called to Lot, "Where are the men who came to you tonight? Bring them out so that we can have sex with them." Lot went outside to meet them and shut the door behind him and said, ''No my fiiends. Don't do this wicked thing. Look, 1 have two daughters who have never slept with a man. Let me bring them out to you, and you can do what you Iike with them. But don? do anything to these men, for they have corne under the protection of my roof" "Get out of our way," they replied. And they said, "This fellow came here as an alien, and now he wants to play the judge! We'll treat you worse than them." They kept bringing pressure on Lot and moved forward to break down the door. But the men [angels] inside pullecî Lot back into the house and shut the door. Then they struck the men who were at the door of the house, young and old, with blindness so that they could not find the door. (Genesis, 19: 4-1 1) In my allegory, the mob of Sodomite men represent the common sema1 practices or sexual realities operating in Anguiila. As the father and hoa, Lot stands for Anguillian power-brokers and decision-makers who publicly seek to protect and prornote scripturaüy defined sexual ideals.

Lot's daughters symbolize the adolescents of Anguilla. As the foreigner, and figuratively Lot's guest, I occupy the position of the angels. Lot chooses to expose his virgin daughters to sexual assault at the hands of an angry mob in order to obey God's law and demonstrate his righteousness. In Anguilla, young people's sema1 and reproductive health is comprornised by large discrepancies between the common Anguillian sexual practices and the dominant ideals for sexuai behaviour. It is important to note that Lot does not offer his own body as a sexuai substitute for those of his guests. Nor does he tell the mob that they dlonly gain access to his guests or his daughters "over his dead body." Instead of sacrificing hirnseif to maintain God's law, Lot is prepared to sacrifice the most vulnerable members of his famiIy. Likewise, using the language of the Bible, public figures and decision- makers in Anguilla decry the sexual practices of adolescents as a sign of the moral decay of Anguilla, whiie avoiding risk to themselves by remaining sitent about how they and their adult constituents benefit fiom and are irnplicated in creating the socio-economic conditions that influence adolesent sexual behaviour. As a foreigner and an employee of the Anguillian government, 1 am positioned as Lot's guest. The angels' visit brhgs the Sodomite men to Lot's door; the research 1 undertook in Anguilla created a situation of potential nsk for Anguillian adolescents. In the story of Lot, the well-being of the daughters is subservient to the protection of the father, his righteousness, and obedience to God's law. By blinding the Sodomites and bringing Lot indoors, the angels protect the man who has acted to defend them and the laws of their god; they also protect themselves.

Presumably the daughters are also saved fiom the mob, but just as the angels are not recorded as protesting against the sacrifice of Lot's daughters, their salvation is not deemed worthy of note. However, my objectives difTered fiom that of the angels in the story of Lot. 1 did not believe in the scriptural proscriptions regardhg sex ascribed to by Lot, nor did 1 percieve my role to be punishment of sinners. While the actions of the angels demonstrate they were concemed with protecting Lot and enforcing Yahwehts law regardless of the wnsequences for Lot's daughters, protecting and improving the well-being of adolescents was my primary goal in the work 1 undenook in Anguilla. Yet, this intention did not translate unproblematicaüy into implementation. This thesis examines the constraints 1 faced and the strategies 1 deployed during the project. As 1 began to understand the cultural context and heterogeneity of interests surroundhg adolescent health in Anguilla, 1 attempted to shif? my position fkom being Lot's guest, and having my work serve Lot's interest, to creating a space where Lot's daughters, the adolescents of Anguilla, could articulate their interests and strategize around their own weli-being. The first chapter is concerned with methodology. 1 situate my concerns as a researcher and consider how adolescent sema1 and reproductive heaith became identifkd as a priority health need and why a survey was selected to investigate and describe this need. The dominant AnguiIlian narrative about a "teenage pregnancy crisis" is explored and problematized, and my research questions and objectives are clarified. The second chapter describes rapid changes to Anguilla's economy in the past two decades. Rapid economic growth has resulted in difiùsion of foreign ideologies through new communication technologies, education of AnguiIlians overseas, and the expansion of activities of international development agencies. Social uncertainty produceci by rapid economic growth and the chdenge to the hegemony of traditional cuttural leaders, caused by the arrival of foreign discourses, provided the conditions for a moral panic about adolescent sexuality. The moral panic that constructed adolescent sexuality as a "crisis" and sign of the moral decay of Anguihan Society contnbuted to the identification of adolescent sexuality as a priority health need and provided the conte- for the research and dissemination of the research findiogs. Chapter three explores four competing messages about adolescent sexuality which were circulating in the Anguiiiian public sphere during the project. 1 hypothesized, and continue to assert, that these contradictory discourses represented a barrier to Anguillian adolescents achieving their optimal sexual and reproductive health. Based on the gap between the sexual ideals and sexual realities of Anguillian adolescents revealed by survey data, 1 constructed an argument for improved and extended sexual health education and seMces for youth. My identification of the moral panic about adolescent sexuality engendered further objectives for research dissemination. 1 realized the survey data could be used to "add fuel to the fie" and harrn Anguillian adolescents by providing a justification for terminating existing sema1 health education and services or contributing to discourses that constmct young people as morally compt. It is in this sense that, jun as the angels' arriva1 in Sodom brings the mob of men to Lot's door, the research 1 conducted posed a potential risk to Anguillian adolescents. Consequently, 1 fiamed the presentation of the data to chailenge the underlying assumptions behind the moral panic. Chapter four recounts the argument 1 presented to five groups of community stakeholders and the local media. The fifth, and final, chapter evaluates whether the eight-month project contnbuted to my intended objective of improving the well-being of Anguillian adolescents. 1 evaluate three aspects of the project. First, 1 examine the validity of the identification of adolescent sexual and reproductive health as a topic of inquiry. Second, 1 consider the extent to which sharing the survey data in community consultations and through the mass media supported a discussion of adolescent sexuality and reproductive health that did not simply reinscribe the categones of the moral panic. Third, 1 question the relationships between the strategies generated as a result of the project, the research design, and actions taken to improve adolescents' sexual and reproductive health. CaAPTER ONE: THE RESEARCH PROCESS Needs Assessrnent

"...ad is ais0 a political instrument, meticulously prepared, calculated, and used" (Foucault, 1979,26). The construction of need and carrying out research designeci to describe how to meet this need is a political process: "the interpretation of people's needs is itselfa political stake, indeed sometimes the political stake" (Fraser, 1989, 145). Yet, much research methodology and the presentation of research obscures the power relations that are simultaneously presupposed and constituted during the production of knowledge. Foucault ascribes the partial invisibility of power as a tactic that contributes to the maintenance of the status quo: "power is tolerable only on condition that it mask a substantial part of itself. Its success is proportional to its ability to hide its own mechanisms" (Foucault, 1978, 86). The invisibility of the researcher in social sciences has been made dominant through the adoption of neo-positivist methodology f3om the hard sciences. Within this paradigm people are treated as objects about whom the researcher can gather data which appûars unrelated to the researcher's own subject position or interactions with the people studied. The results are then presented in a way that makes the researcher, the power relations between research and researched embedded in the research process, and the social relations which create the "need" for research invisible (Schrivers, 1995, 20). The aim of this chapter is to make the sociai relations which shaped the research 1 conducted in Anguilla between August 1998 and March 1999 more visible. 1 will do so by situating the researcher and explicating the social relations that contributed both to the constitution of adolescent sexual and reproductive health as a priority health need and to the selection of a survey as the means to investigate and descnbe that need. Pre-Departure Preparation Prier to my involvement, the previous Senior Medical Health Officer and previous Permanent Secretary of Social SeMces, in conjunction with the Canadian non-govemmental organization that sent me to Anguilla, identified women's health as a prionty for the island. These decision makers were undoubtedly aware that meeting basic human needs, including primary health care, and women in development are among the Canadian International Development

Agency's six priorities for development (CIDA, 998). Through ailocation of fùnds from CIDA and Human Resources and Development Canada, I was hired on a six-month contract to research and design programming related to women's health. The subsequent identincation of adolescent reproductive health as a priority area for research within the field of women's health was produced by three impulses. Chronologicaily, the first impulse derived from my own education, pre- departure preparation and uiterests. Secondly, on arrivai in Anguilla, 1 conducted interviews and focus groups with Anguillian stakeholders as a needs assessrnent for women's health. The third factor contributkg to the choice of reproductive health as a pnority issue was my analysis of P~cessAiexandra Hospital birth records for teenage mothers for the twenty-five years between 1972 and 1997. In preparation for my arriva1 on Anguilla, 1 attempted to reach the Permanent Secretary of the Ministry of Social Services, who was my Anguillian contact person, and a foreign doctor who runs a chic in Anguilla to 6nd out if there were resources 1 could bring fkom Canada which might be useful for the project. 1 was unable to speak to the Permanent Secretary but 1 reached the doctor. During our telephone discussion, the doctor indicated that her patients included approxirnately three thousand of the ten thousand people living in Anguilla; she told me that reproductive and sexuai health was a priority. In particular, the doctor identified low levels of knowledge about reproductive biology as a problem and suggested a need for pamphlets and other educationai matenals. Consequently, 1 collected and transported to Anguilla approxirnately thirty kilograrns of pamphlets, posters, videos and training manuals related to sexual and reproductive health to Anguilla. This doctor's identincation of sexuai health as a priority area for women resonated ~5th me because of what 1 aiready knew about the global epidemiology of HIV/AIDS and the modes of HWA1.Stransmission in this region. For women in the Caribbean, pnmary heaith concerns are sexually transmitted diseases, domestic violence, abortion, early pregnancy, cancer, hypertension and diabetes (Coq 1997, 383). Afiica and the Caribbean, particularly Haiti, were identifieci early as epidemic foci of AIDS and HIV infection (Carael and Piot, 1989). As of June 10, 1996, Latin America and the Caribbean accounted for twenty-six percent of the total cases reported to the Pan American Health Organization and slightly more than thineen percent of the cases reported to the World Health Organization (UNAIDS,1998a). While the first cases of AIDS in the Caribbean were reported among homosexual and bisexual men, incidence among heterosexuals quickly came to dominate. From 1985 to 1991, reports of cases among homosexual and bisexual men fell from fifty-one percent to sixteen percent, while heterosexual cases increased ftom thineen percent of cases among aduits to eighty-three percent. Furthemore, as of 1991, ninety-nine percent of reported cases of AIDS in the Caribbean were attributed to senial contact (Wheeler and RadcWe, 1994, 79-81). The rates of HIVIAIDS infection Vary dramatically in the Eastern Caribbean, with some islands reporting rates of incidence among the highest in the world, but the primacy of heterosexuai transmission is quite uniform. Despite the fact that nomindy confidentid HIV testing is available in the Anguillian public health service,3 surveillance of HiVIAIDS is extremely unreliable because people who have the ability tend to travel off-ishd for medicai seMces they perceive as sensitive (interviews with Director of Primary Health Care, August 10, 1999; inte~ewwith Senior Medical Officer, August 20; Carter-Davis, 1997). The easiest off-isiand access to medical services is on St. Martin, a thirty-minute ferry ride fiom Anguilla. Halfof St. Martin is a French department, legaily part of France, and the other haifis a Dutch dependent temtory. St. Martin does not appear in the WIAIDS surveillance of the Caribbean done by UNAIDS (UNAIDS, 1997). Nor has the Anguillian public health syaem articulated a means of information sharing with doctors or hospitals in St. Martin. Ifblood samples are taken in Anguilla and test positive, they are sent for re-testing at the Caribbean Epidemiology Centre (CAREC) in Trinidad. While Anguilia may

3~loodsamples are de-as an effort to provide anonymity to the patient. However, the rouiines of work and Ne of the population mean that people other than the Iab technician are at least perceived by the patient to be aware of their results. A fnend remunteci an incident where he was required to give blood for an cmergçncy transfusion to a family member. He stated that his blood sample was testcd for MVwhile he and various other hospiîal workers were still in the lab, making his association with the test resuits apparent to anyone who cared to pay attention. This individual may have misinterpreted what was actually occuring with his blood sample. However, it is the perception of nonconfidentiality which pushes Anguillians to seek health care off-idand,The fkquency with which 1 was told similar accounts of non-confïdentiality. my own observations of the handliog of medical records, discussions of cases by providers, youth perceptions of confidentiality recordeci in the National Adolescent Reproductive Health Survey, and my own concerns about confidcntiality when seeking health services all support patient conanis about coafidentiality. appear in the aggregated statistics for HIVIAIDS in the English-speaking Caribbean, no dissaggregated statistics for Anguilla appear in HIV/AiDS surveillance documents for the English-speaking Caribbean f?om UNAIDS. Thought to be only the tip of the iceberg by Angutllian hedth professionais, the most accurate assessment of HIV1AI.s incidence available was a compilation of cases by Primary Health Care in 1998. Anguilla's conformity with the patterns of heterosexual transmission seen in the rest of the region is suggested by the fact that of the sixteen cases identifid by the 1998 audit, nine were men and seven were women (Rogers, 1998). Class, culture, race, ethnicity, nationaiity, religion and many other complex overlappings and intersections of identity and Me history nuance al1 aspects of women's lives: "roles show similarities and differences between classes as well as societies, and since the way they are socially constructed is always temporarily and spatially specific, gender divisions cannot be rad off on checklists" (Moser, 1989, 1800). At the same time, physiology and the gendered roles for sexuality in most cultures increase women's risk for HIV infection. Women's social and biological vulnerability to infection with HIVIAIDS means t hat in communities where heterosexuai relations are the primary mode of transmission, the ratio of women to men who become infected tends to rise rapidly and exponentially when the virus is introduced. Biologicdy, women are more prone than men to contracting HIV.HIV is more highly concentrated in seminal fluids than in vaginal secretions and in comparsison to the circumcised or uncircumsised penis, the cervix and vagina provide a much larger surface area that is vulnerable to infection. Consequently, researchers have estimated that male-to-female transmission is from twelve to twenty times more likely than female-to-male transmission (haro, 1995; Simmons et ai, 1996, 47). Risk of transmission is excacerbated by genital trauma. Younger women are more likely to experience genital trauma because their lower reproductive tract is not fùlly developed, however physically mature women are also at risk from sexual practices such as foregoing foreplay and vaginal drying (Simmons et d, 1996, 47-48).

The biological risk of contracting HIV is also increased by the presence of other sexualiy transmitted diseases. Epiderniological studies in Anica, North Arnenca and Europe have suggested that there is approximately four times greater risk of HIV-infection if the person has a genital ulcer such as those caused by syphilis. There is also a signincant, if less dramatic, Uicrease in risk of HIV infection in the presence of STDs such as gonorrhea, chlamydia and trichornoniasis (Aral and Wasserheit, 1995, 15- 19; UNAIDS, 1995). The prevalence of STDs in the Caribbean indicates sexual practices which makes HIV transmission possible and increases concems about the probability of transmission. For comparison, the estimated prevalence of STDs per thousand people aged fifteen to forty-nine is eight in North Arnerica, twenty-four in Latin America and the Caribbean, and fi*-three in Sub-Saharan Afnca. In most cultures, women are made sociaily wlnerable to HiV/AIDS because the way sexuality is gendered places decision-making power and sexual rights in men's hands and assigns women sexual cornpliance and obligations. Men and women ofien see men's sexual pleasure or fulfilment as a male right with which women need to comply (Che and McKenzie, 1996, 370-

374; Holland et al, 1990, 340-341). The negation of women's expectation of and expression of sexual desire is hypothesized to act as a barrier to women practicing safe sex because women are not accustomed to thinking about what they want sexually, let alone asserthg it to their male partnen (Fine, 1985; Tolman, 1994; Tolman and Higgins, 1996; Weiss and Gupta, 1998). In conjunction with negating or hting women's expectation and expression of autonomous sexual desire, these roles create a situation in which the options women have for protecting themselves fiorn HIV/ATDS, such as retiishg sex or insisting on safer sex, demand that they transgress dominant gender dynamics (Che and McKenzie, 1996,370-374; Holiand et al, 1990; Kippax, Crawford, Waldby, 1994; Sosnowitz, 1995; Travers and Bennett, 1996, 67-68; Weiss and Gupta, 1998, 2-3). Women's lesser ability to avoid the nsks of sexually transmitted disease based on their sexual subordination to men is compounded when cultural noms exalt monogamy and mutual fidelity and expect women to adhere stnctly to this nom while tacitly condoning male deviation fiom it. UNAIDS iiiustrates this phenornenon by quoting a woman describing a husband coMng home inebriated, smeiiiig of strange perfume, and insisting on sexual intercourse as a proof of his sexual fidelity, when in fact he has been unfaitfil: "You have to go dong with whatever he asks, even if you're smelling this strange perfume, because you can't Say no" (UNAIDS,l998b). Women's ability to challenge these sexud role expectations in order to protect or improve their sexual and reproductive health is fiequently compounded by their economic and social subordination to their male peers. The biological and social vulnerability of women to HIVIAIDS has resulted in the rapid growth of the number of women infècted with the virus. As early as 1989, AIDS was the leading cause of death for women between twenty and forty years of age in the large urban centers of the Americas, Sub Saharan Anica and Western Europe (Chin cited in Sobo, 1995, 10). As a global group, women have changed fiom being almost invisible in the global pandemic in the early eighties to representing aimost half of dl new infections worldwide at the end of the 1990s (UNAIDS, 1998b). As the effects of class, race, nationality, and ethnicity would suggest, the pandemic has not affected d women equally. Globally, it is poor people, but particularly poor women, who are disproportionately represented among new infections (Aral and Wasserheit, 1995, 13- 14; Simmons et al, l996,39). 1 could not assess how the economic, social, and sexual relations operating in Anguilla would contribute to or mitigate various Anguillian women's vulnerability to HIVIAIDS before arriving on the island. However, the fact that women in the Commonwealth Caribbean represent a higher proportion of AIDS cases than any other region in the Western Hernisphere prepared me to identiQ sexual and reproductive health as a priority heakh need for women in Anguilla (Allen, 1997, 197). The focus on adolescents was suggested by the fact that globally, youth are the group most at risk of infection with a sexudy transmitted disease, and young women are most at nsk among that group . The World Health Organization estimates that worldwide halfof the people infected with HW have been between tifteen and twenty-four years of age. in many countries sixty percent of new infkctions are among fifieen to twenty-four year olds, and the male to female ratio is now inverteci with two females being infected for every male (UNAIDS, 1998a; UNAIDS, 1998b). In Caribbean countries that report the age of AIDS patients, the average age of female patients appears lower than the average age of male patients, more than twenty-seven percent of females with AIDS are less than twenty-five years old as opposed to seventeen and a half percent of males with the disease (Kimbdl, Gonzalez and Zacarias, 1991: 369-370). The patterns of transmission led to the assertion as early as 1989 that AIDS could quickly become the leading cause of death for young people in the Caribbean (CAREC, 1989). Despite the fact that on some islands AIDS is now the leading cause of death for young men, for the region as a whole, women aged meen to nineteen years now have higher annual incidence rates than men of the same age

(UNAIDS, 1998a). The global and Cax-ibbean incidence of sexuaüy transmitted infectjons and the social and economic conditions and patterns of sexual behavior which rnake young people, especiaily young women, particularly Milnerable to infection suggested this age group as an important population to study.

Interviews and Focus Groups

Upon arriva1 in Anguilla, 1 conducted a needs assessment with local seMce providers, advocates and representatives of the population using semi-structured inte~ewsand focus groups. The inte~ewsand focus groups were my introduction to the stakeholders in the broadly defined health field. 1 intervieweci senior management4 in the Ministry of Social Services; Anguilla's Medical Health Officer; midde management and fiont line workers in primay health care, secondary health care (P~cessAlexandra Hospital), education, community development and welfare, and two community advocates, one who headed the island's most active non- governmental organization, the Anguilla National Trust, and another with a background in social work and community development, who was providing counseling and support to several teenage mothers. 1 conducted a focus group with twelve women whose ages ranged from sixteen to the mid-mies within the context of an in-service training for current and potential clinic aides? 1 also

"niroughout the thesis, I use "upper management" to refer to the Permanent Secretaxy of Social Se~oesand the Directors of Primary Hedth Care and Secondary Health Care. In the governance structure of Anguilla, the Permanent Secretary is a technocrat who manages the Ministry. similar to a Deputy Minister in Canada. The Minister is the elected official. The Minisiers bclong to a body narned the Esecutive Council, which has a fuaction similar to the Cabinet in the Canadian parliamentary system. 1 label the Directors of primary and secondary health care "upper managementu because they were welleducatcd men whom I observed making decisions about the allocation of tesources in dose contact with the Permanent Secretary. Conversely, 1 include the directors of education and commuaity development as middle management because 1 did not observe them working closely with the Permanent Secreîaq or aiîocating resources; it is interesthg to note that the directors of these two departments were relatively les educated and, were wvomcn. I include individuals who did administration as well as providing seMces in middle management. Front-fine workers (teachers, nurses, etc.) are definai as those who deliver services but are not responsîble for administration. More analysis of the gender and education hierarchy in @e social services sector in Anguilla is included in Chaptcr Five. 'In the Anguiliian health care system, clinic aides are assistants to the registcred nurses. facilitated a discussion with a mixed sex group of five older youth, two of whom were sixteen and three who were in their early menties. These young people were good fnends. Their body Ianguage and banter during the group inte~ewsuggested they were cornfortable discussïng controversial topics such as dating and condom use, though they informed me this ease was unusual. They were also active members of Anguilia's non-denorninational youth organizations and as such were able to idorm me about programs and seMces available to Anguillian youth, youths' use of those services, and perceived service gaps. The overall focus of inquiry was priority heaith needs of AnguiMian women in al age groups, however, 1 included a question pertaining specificaily to the health needs of young wornen. The needs assessment covered the following topics: priority health needs, current seMces and modes of service delivery, past programs and services, identifieci gaps in service, perceived baniers to individuais accessing health care and identification of stakehotders by the int eniewee. A variety of issues were raised dunng the needs assessment. For adult women, the absence of mental health fiom the service continuum and a perceived lack of confidentiality in the health care system were cited frequently as gaps in the health care system and barrien to access. Young people cited lack of participation or "voice" in decision making and lack of training, employrnent opportunities, access to physical locales, and extra-cumcular activities as important youth issues

(youth focus group, August 19, 1998; Hodge, 1998). Among both youth and service providers, the most fiequentiy mentioned bamer to accessing health services was the perceived lack of coddentiality. Service providers had the perception that youth were not accessing the health care system. One seMce provider explained the situation in the following way: "people come as children with their mothers for the welI baby dinics and their immunizations, then we don't see them again until they are about to become mothers themselves" (heaith seMce provider, August 18, 1998). Youth expressed concern about a lack of confidentiaiity and a conviction that avaiiable seMce providers were unsuitable because of their close links with family networks: "If they lyoung people] use contraceptives, it's condoms. But people aren't going to go to the clinic because you might know the nurse. She might know you or your family, and then you are hearing this whole aory" (youth focus group, August 19, 1998). The youth perception that health seMces were not confidentid and the seMce provider perception that young people were not using publicly available seMces suggested to me that assessing how young people currently used the health care system and determinhg their preferences for service delivery was necessary in order to decide how to improve health services for youth in Anguilla. In terms of health issues, reproductive health was central for both adult and adolescent women. Arnong adult women, topics raised varied from concems about ceMcal cancer and sexuaiiy transmitted disease to barriers to women making reproductive choices because cultural noms, even if contradicteci by law, assigned reproductive decision-making power to men without insisting on male responsibility for the outcornes. Poor nutrition was mentioned with reference to youth and children, but the fiequency and vigor with which adolescent reproductive health, particularly teenage pregnancy, was mentioned identified the area as a priority. Most of the people who mentioned teenage pregnancy posited a causal relationship between rising rates of teenage pregnancy and the promulgation of legislation that allows pregnant girls to remain in school and teenage mothers to return to the education system. This legislation was instituted by the British in 1995 in the face of local resi~tance.~Informants felt allowing girls to return to school removed a disincentive to pregnancy. Sewice providers and young people both expressed this belief Cornments such as "Now they can go back to school, they dont mind getting pregnant" (semice provider) and "you won? get kicked out of school if you get pregnant, but when 1 was in school, 1 knew that if1 got pregnant, that was it, a blighted life" (youth focus group) are representative. For most of the Anguillians 1 consulted during the needs assessment, high priority was accorded to adolescent sexuality as a health problem. The association between teenage mothers being able to return to school and increased numbers of young women becoming pregnant was presented by

- ohmlais a British Dependent Temtory. Therefore, Britain has the legal right to force AnguiIlian law to conform to British law. The legislation wvith regards to teenage mothers is an example of the Crowvn exercising this right. nere was a great debate in the Spring of 1999 in the Bntish Dependencies about the possibility Britain would eradicate the death penaity and criminalization of homose.wal acts. them as a self-evïdent tnith. 1, on the other hand, was skepticai of the explanation offered for rising teenage pregnancies:

Anguillian culture hais utdergone the shock of movingfrom subsisfence agriculture to an muent consumer socieîy in the spmt of twenty-five yems or less. The rapidity of social change cotdd create a large pool of nostulgrgriafor the god old &ys andparticulmly the gwd old wqys. I have a suspicion- thmgh 1 don7 know if it is me- 1 will hove to ver@ thar teet]pregnancy has not risen in the pan years but thit is beingfamed in a new way. [Health cme provider/ made me think that &y noting afiiend's comment that the situation hasn 'I change4 but we look at ifdlflerentlj trow and that if she had had access tofmiiy planning, she 'kml&'l have had zhat morty childenfor no man." I wmld argue thaï unfess the sociul values around fmiiy, semaZity, men ami won>enhe changed &amc~ticaf/y,the fuct that the technicalfix exists d's not mean thit wilf be utilized (Field Notes, AU~US~14, 1998). My skepticism as to whether aliowing teenage mothers to retum to school was causing an increase in teenage pregnancies as well as my focus on social relations around teenage pregnancy sprang from two sources. Farniiiarity with critiques of international development that analyze the tendency to reframe issues of power as technical issues caused me to cast a suspicious eye on the portrayai of family planning as a quick, easy and value neutrai solution. Just as 1 do not believe access to hormonal contraceptives cm magically alter social relations to give women total control over their own fenilty, it was not credible to me that young women who had been avoiding pregnancy would suddenly bewme pregnant because they would no longer be expelled fbm school ifthey did so. Secondly, punishrnent as a prevention strategy for teenage pregnancy was completely absent fkom the reproductive health literature 1 had read.

Ferguson (1 994), Shiva (1 989; 1992) and Escobar (1 995) have been critical of the ways in which international development constnicts discourses that obscure politics by "casting political questions of land, resources, jobs or wages as technical 'problems"' (Ferguson, 1994, I 80). In this anaiysis, international development discourse and the practices it supports are seen to actually irnpede a bettering of the conditions of the people development experts purport to help by rnisrepresenting the issues and making more resources available to the social groups who benefit fiom the status quo. The symbiotic powerknowledge relationship between demography and the international fdyplanning establishment, the associated concept of the demographic transition, and the focus on contraceptives as a solution al1 suggest that interventions that are purported to be "value neutrai" and "non-political" are at least partially ideologically motivated. Demography has retained the concept of demographic transition, which describes the interaction of reproduction and development as mirroring the structure of western society, asserîing "fertility transition is caused by and in tum causes further Westernization and that reproductive Westernization is good for everyone" (Greenhalgh, 1996,27). The ways in which demographic transition is Linked with eurocentric models of modemkation or development was demonstrated at the Internationai Conference on Population and Development held in Cairo in 1994. The theme of the conference was women's empowerment, however, empowerment frequently translated into modem economic development: "We firmly believe that the empowerment of women in terms of literacy, employment and access to quality health care and family planning will lead not only to greater equality but to faster economic growth as well" (India's Minister of Health and Family Welfare, cited in Johnson, 1995, 147). Demographers ofien explah large families as the result of the family need for labor power, high infant mortality, and the need for offspring as a source of economic securiîy in old age. This logic underlies the famous assertion of the non-aligned nations at the 1974 Bucharest Conference on Population and Development that "Development is the Best Contraceptive." Family planning billboards depicting small families in western dress and statements such as "What we want is not more people but more things for people" (Chief Health Minister of India, cited in Diamond, 1994, 132) attest to the dominant vision of the developed fùture. Confiation of women's empowerment with access to contraceptives and the ability to participate as wage earners in a consumer society depoliticizes the issue in that it does not respond to the specific historicai conditions of women's lives. Furthemore, contraceptives are the quintessentiai "technical h"in that they purport to allow (primarily) women to control their fertility while sidestepping the social and econornic conditions that inhibit (prirnarily) women's sexual and reproductive decision making. Any genuine effort to improve health outcomes must look beyond the individualistic adoption of technologies such as contraceptives or condoms and look towards the structurai determinants of health (Hertzman et al, 1994; Freudenberg et al, 1995, 273; Doyal, 1995). The structurai determinants of HIV/AIDS are dernonstrateci by the fact that marginaiized people are over represented among those that have been infected. More than ninety percent of infections with HIV have occwed in the majority world and growing numbers of women, particularly poor young women, who are being infected with HIV illustrates their structural position as the moa vulnerzble of the dise&anchised (Farmer, 1996,21-3 1; Simmons et al, 1996).With regards to women and HIV/AIDS, it is wise to be wary of strategies that place responsibility for safer sex on women without recognizing how their structural position wiU influence their ability to effect change, for example, by insisthg on condom use. Unequai power relationships that constmct sexuality, such as the threat or actuality of male violence against women, or pende penetration of the vagina as the defining act of heterosexuality must be considered structural barriers to women's

ability to practice safer sex (Kippax et al, 1994, 3 19; Weiss and Gupta, 1998, 2- 10). Effective HIV/AlDS prevention and treatment strategies need to take into consideration the structural barriers people face, address thernselves to communities rather than to individuals, and make their goal transfonning societies to better meet people's needs rather than simply proposing individually targeted, technical solutions, like the condom (Rhatigan, 1996, 185- 191). Vulnerabiiity to HlV/AIDS exists dong a spectrum, and the relative importance people accord to AIDS prevention and how they conceive of their arena for action must be considered within the context of a hierarchy of risk. At the far end of the spectrum, a hostile physical

environment or an abusive relationship may be barriers to the practice of safer sex. For example, a participatoty evaluation of AIDS education workshops delivered to low-income, Sao Paolo youth supported previous hdings that gender roles and other power imbalances between partners are the primary barriers to sexual negotiation. However, scenes created by participating in forum

theater showed how environmental challenges such as finding a private, secure place to have sex, or havhg sex in a public place mitigated against condom use. In this context, "AIDS is seen as just 'another risk' and dersex as a 'burden' among many troubles" (Paiva, V. and Skinner S., 1996). Likewise, for many poor women AIDS is just another problem they have to take

responsibility for: "They ask, 'How am 1 going to take care of my family?' '1 have to put food on the table now.' 'You thuik AIDS is a problem! Let me teU you- 1 got real problems"' (Ward cited in Farmer, 1996, 23). Some of the problek associated with avoiding the risk of HIV infection may be associated with unequai power relationships between men and women in heterosexual relationships. At the far end of the spectrum, violence in intimate relationships, in particular men's violence against women, has been identified as a factor in the transmission of sexualiy transrnitted infections (UNAIDS, 1998b). For a woman who is being battered, negotiating condom use may not be feasible; simply attempting to do so may threaten her well-being. However, even if a woman is not being beaten, the perceived threat of violence, belief men will use violence to gain sexual access, and sex roles based on a male's right of access to fernale bodies create a social context which mitigates against women's attempts to negotiate condom use: "the context of institutionaiized heterosexuality [which] defines male dominance as normal, defines semai intercourse in terrns of men's satisfaction, and turns sexual encounters into potential power struggles" (Holland et ai., 1990, 342).

Anguillian sex roles, which subordinate women to men and can contribute to women's vulnerability to HIV/AIDS, as well as other STDs, and unwanted pregnancy, were made evident during the 'ieeds assessment. One example of how women's sexual and reproductive identities are subordinated to men is the fact that although wornen can Iegdy agree to their own tubal ligations, common medical practice is not to perform the operation without a husband's consent (Field Notes, August 1 1, 1998). An Anguillian service provider described the local mentdity about sexual expectations in the following way: "If a husband comes home dmnk and wants to sleep with her, she has to go lie down because 'I'm his wife"' (Field Notes, August 13, 1998). Young people echoed the differential decision-making power of men and women, stating that young women don't feel ownership of their own bodies and noting that these imbalances are exacerbated by age differentials between partners (Field Notes, August 19, 1998). Further, ideals for sexuality can create situations of risk, particularly when these ideals do not correspond with prevailing sexual practices. For exarnple, unsafe sex may offer psychosocial benefits by acting as "proof" the relationship conforms to desired noms when, in fact, individuals are aware or suspicious that it does not. Condoms are fiequently viewed as an indication of distrust, infidelity and possible presence of stigmatized sexually transmitted diseases, induding HIV/AIDS (Che and McKenzie 1996; Kippax et al, 1994; Metts and Fittpaîrick, 1992; Sobo, 1995; Sosnowitz 1 995). Sex without a condom implies that your sexual relationship conforms to cultural noms of monogamy, fidelity and associated values of love and trust and thus offers the social status and self-esteem associated with attaining these objectives (Margiiio and Imahon,

1998, 5 1-58; Sobo, 1995 ). Sobo's carefùl ethnographic study with inner-city AfXcan-American women details these dynamics and the related phenornenon she labels "AIDS nsk deniai" (Sobo, 1995). A story told to me by a wornan who onginated elsewhere in the Caribbean but had Iived in Anguilla for many years reflected the dynarnic of denial describeci by Sobo: A woman "cooped" [spied on] her boyfiiend to find out if he was cheating and discovered he was. She contionted him and the relationship was terminateci. My informant felt that the wornan who "cooped" was foolish: "1 would never, never do that. You iose your man, and you make yourselflow" (Field Notes, October 11, 1998). While this person made no mention of sexual practices, it is clear she considered it preferable to remain ignorant of intidelity thm risk sacritichg the relationship and shultaneously demeaning herself by being jealous or suspicious (even though the suspicions were correct!). My awareness of the complex social relations related to unsafe sex practice made me skeptical a change in legislation allowing teenage mothers to return to school had resuited in a steep increase in the number of teenage pregnancies in Anguilla. Senial behavior tends to be influenced by complicated interactions of factors. For exarnple, motheh education, reiigious affiliation, age at menarche, and famiiy stability have been shown to have a considerable influence on when young women begin having sexual intercourse. The fewer years of education completed by the mother, the weaker the religious affiliation, the younger the age at menarche and the less stable the famiiy is at the age of fourteen years, the earlier first intercourse tends to occur (Cates, 199 1, 89). Studies of teenage pregnancy in the United States suggest daughters of teenage mothers are more likely than other girls to become teenage mothers themselves (Moore et al, 1998). In the English-speaking Caribbean, the cycle of teenage pregnancy is also intergenerational; interdictions by female kin against sexual activity and earlly pregnancy are rnitigated by the fact that "Wtuaily ali the female sex around her are, or have ben, engaged in the same process" (Senior, 1991, 72). Given the depth and intricacy of relationships shaping sexual practices, 1 did not believe punishrnent, such as being excluded 6om school, was likely to prevent teenage pregnancy. Most studies look at preventive rather than punitive measures for preventing teenage pregnancy. Interventions may be aimed at delaying the onset of semal activity, increasing contraceptive use or changing lXe conditions to encourage young women to avoid childbearuig or second pregnancies. The success of the programs at meeting their goals Vary; however, none of the programs suggest punitive measures (Hofferth, 199 1; Nitz, 1999). In fact, encouraging teenage mothers to continue their education is one of the most highly touted means of preventing subsequent pregnancies. Supports to continue or return to education after childbearing and provision of child care show good short-term success in preventing repeat pregnancies (Hofferth, 1991). Studies of social and economic indicators for Latin America and the Caribbean focus on the efficacy of education for improving quaiity of Me outcomes for young mothers and theîr children and for diminishing the probability of subsequent pregnancies during adolescence

(Econornic Commission for Latin America and the Caribbean, 1997, 1 24-1 21).

1 was skeptical about the cause offered for the rise in teenage pregnancies but interested in the issue because of the intensity with which the subject was discussed. In order to fiirther investigate teenage pregnancies, 1 1ooked for a source of information which could provide a historical perspective on teenage pregnancy in Anguilla and reveal whether or not teenage pregnancies were nsing. Abonion is iilegal in Anguilla, and, therefore, it was not possible to measure the actual number of pregnancies; however, 1 was able to review the birth records at

Princess Alexandra Hospital f?om 1972- 1997. Births To Teenage Mothers Examination of the binh records of the Princess Alexandra Hospital provides a fairly accurate picture of births on Anguilla because it is the idand's ody hospital and because during the time penod studied, hospital births were the nom (Field Notes, Augun 13 1998 and August

20, 1998). The variables examined were: age of mother, order of pregnancy (first pregnancy, second pregnancy etc.), vagiml deiivery, cesarean delivery, still births, pe~atalmortality, neonatal mortality, matemal mortality, abortions and ectopic pregnancy. The birth outcornes for Angufian teenagers were relatively positive when compared with intemational data on early childbearing, which indicates girls aged tifteen to nineteen are twice as iikely to die as a result of childbirth as women in their twenties (www.who.int/whday/en, 1998). In Anguilla, infit and matemal mortality, stillbirth and cesarean sections were rarer among mothers under twenty than in the total population of women who gave birth between 1986 and 1996.' Figure 1 : Bhhs to Teenage Mothers, 1972- 1997

a-8percentage of birins Co men under 20 nurnbenof birVu to women under 20

'This is a crude me~urras 1 did not mrdy the incidence of low-birth-weighi babies, prernanut births, or der obstetric complications. What was surprising about the birth records for the years 1972-1997 in relation to the interview portion of the needs assessment was that they revealed a dramatic and continued decline in births to teenage mothers from the late seventies until the late nineties. The vocal concern about a rising number of teenage pregnancies in recent years was not supporteci by the number of births, which decreased both in terms of actual numbers and the percentage of births to teenage mothers relative to the total number of births. It is important to note that birth records indicate only the number of births and not the number of pregnancies. However, whiie an increase in illegal abortions on Anguilla, teenagers seeking legal abortions on other islands, or teenagers going overseas to give birth, are other possible explanations for the declining births to teenagers, fewer young Angdian women becoming pregnant is the most logical explanation for the decline in births to teenagers. The decline in birtfis to teenage mothers begins in the late seventies and bewmes even more pronounced in the mid-eighties. The pattern suggests two potentidy related phenornenon and refers us back to the social relations that produce the conditions for sexual practice. Prior to the Md-eighties there were few education or employment opportunities available to young women. Up until 1985, admission to secondary school was by examination, and, as a consequence, the vast majority of Anguillian youth did not continue to secondary school (Edwards, 1997,4-5). Historically, women have been primarily responsible for subsistence in Anguilla. Ewages were earned, it was by men, either locally or overseas. The development of tourism in the mid-eighties provided women jobs in the domestic and senice sector. The decline of births to teenage mothers can be at least partially explained by increased access to education and employment, as these opportunities have been found to deter childbearing (Hofferih, 1991, 9-

1O). Re-Defining the Problem and the Pmject

This does not men that the reseatchet or nctivikî kas to &pt the subjecîs' view or that the subjects' view is ahvays right. /.../ It means that the i~erpretive sociai scie- has to take into account people's own descriptions as the starting point of thwryythat is, of what hm to be explained ~scobar,1995,101). The discrepancy between the narrative about a teenage pregnancy crisis, expressed during the needs assessment, and the decline in births to teenage mothers demonstrateci by the birth records and supporteci by my own skepticism with regards to educational opportunities leading to increased pregnancies among teenagers, caused me to question why my CO-workersand acquaintances considered adolescent sexuality one of the foremost social problems on the island. In part, concem about young women becoming mothers could be explained by a redefmition of social expectations based on universal access to secondary education and new employment opportunities. Previousiy, a wornan who became pregnant at fifieen or sixteen would not have been perceived as a "fden schoolgirl" who had "ruined her fùture." Motherhood and participation in the subsistence activities of the extended family unit were the expected trajectory upon the completion of primary school. A fcw of the service providers 1 spoke with reflected on the possibility that expectations of young women had changed more than young women's sexuai behavior (Field Notes, August 12, 1998; Field Notes, August 24, 1998). However, the dominant construction of the teenage pregnancy issue and the tenor of debate was not an expression of concern that teenage pregnancy acted as a bamer to women fiilfilhg an expanded social and economic role. hstead the supposed rise in teenage prepancies was taken as a signifier of a perceived moral decay of Anguillian society.

As my knowledge of Anguilla's past and present increased, 1 became cognizant of the rapid economic growth in the past fifteen years and attendant infiision of new and competing cutturaI discourses. 1 came to identfi the issue of teenage sexuality as a "moral panic." in his seminal text Folk Devils and Moral Panics, Stanley Cohen States a moral panic occurs when: A condition, episode, person or group of persons emerges to becorne defined as a threat to societal values and interests; its nature is presented in a styiized and stereotypical fashion by the mass media; the moral barricades are manned by editors, bishops, po titicians and other right-thinking people; sociaiiy accredited experts pronounce their diagnoses and solutions; ...(Cohen, l972,9). Key to the concept of moral panic is the assertion that the real origins of the issues are ignored

and that the threat represented by the so-cded deviants is overstated. In the case described by Cohen, the outrage and perceived threat associated with violence, vandalism and petty theft carried out by British youth who were identified, and at least partiaily self-identified, as Mods and Rockers, was far out of proportion to the achial events (Cohen 1972). In Anguilla, widespread concern about a "crisis" of increasing teenage pregnancy exists despite a decline in the numbers of teenage mothers. The moral panic does not actually emerge fiom the issue it presumes to address, nor is it orienteci to provide relevant solutions for the problem it describes. Rather, the moral panic fùnctions to afEm or reinforce social boundaries perceived to be under threat by constituting a highly visible threat and positing risk reduction through a return to "traditional" values (Thompson, 1998, 3). The strategy 1 adopted to address the concems about adolescent senial and reproductive health was to investigate the dimensions of the so-called problem. In response to a poorly founded panic about teenage pregnancy and in the apparent absence of any idonnation about the sema1 knowledge, attitudes or practices of Anguiilian adolescents or their attitudes towards and use of health services, research seemed an appropriate next step.

The argument is not that there is "nothing there" [...] but that the reaction to what is observed or inferreci is fbndamentally inappropriate. The initial step is one of unmasking and debunlang ... Once the rdas opposed to the surface legitimations of the societal reactions are exposed, there is a possibility of undermidg them and devising policies that are both more effective and more humane. (Cohen, 1974, 204) The step taken to debunk and understand was a suwey. Survey Methodology The identification of adolescent sexual and reproductive health as a priority health need was influenced by my education, interviews with Anguiilians, analysis of the birth records, and my position as an employee of Primary Health Care. Similady, selection of a survey to investigate the topic was the result of a cornplex interaction of forces. Pnor to arriving in Anguilla, post- structuralist critiques of knowledge production and sexual health education Literature that stressed the importance of individuals' sexual definitions had made surveys something of an anathema to

I would like to leave spoce for wornetr to preserit their self-understandzng, the& world view in the research instead of the calegories being creuted by me and their agency consisting of checking little boxes. The categories created by women to define their own sexuality may ofler great insight into the reasomfor their sed practices . I wmt to create spoce for the other person to challenge rny pestions. (Ket~daIl,Notes on Methodoiogy and Ethics, October 2 7, 199 7) Nevertheless, the research method that 1 used to investigate adolescent sexual and reproductive health in Anguilia was a pencil and paper survey instead of the participatory, process-and- empowerment-oriented mode1 that 1 initially envisioned and embraced as a benchmark of my success.9 Three forces contributed to this outcome. First, as .m employee, 1 was subject to the preferences of my employers for an "objective" and "scientific" research methodology. Related to my employrnent with the primary health care department was my positionhg as a foreign researcher and "expert," which tended to isolate me fiom Anguilla's young people and thereby

* The limiis of the meyas a methodology were highlighted for me by the arguments Escobar (1995) and Ferguson (1994) make about how, witbin the field of intemational development, people and situations are represented and misrepresented by researchers and planners in ways that correspond to developers objectives but are completely alien to people's own understanding of their situation. The possibility for the researcher to impose his or her reality on the research participants is increased by methodologies, such as sufveys, where the researchcr creates the categories. A survey made up of sdes and closed questions laves little room for the participants to define their own rcalities. I believe participants' own understanding of the problems is the most promishg place to look for solutions. With regards to HIWAIDS, the most fundamental questions to be aaswered in order to Limit the spread of the disease are those that ask how individuals and groups make meaning of their se.d practice and xxval idcntity. Tabulating sexual practices and rates of infection has been usefiil for establishing an epiderniological picture of HIV/AIDS, and may in this way assist by indicaihg where resources and attention are bat focused, but the data gathered does Little to facilitate cffeclivc health promotion (Parker, 1995, 261-262). For esample, the tendency not to identifir with targeted "risk groups" has been highlighted in regards to men who have sex with men (MSM), but do not identiQ as gay (Clatts. 1995, 2-41-255). Whiie a survey can identifv men who have sex with men, the methodology does not lend itself to understanding how these men characterize thcir own scxual practices. Without a contextualized understanding of MSM's sexual practîce, it is difficult to create health romotion sirategies that fespond to men's experiences in these conte-m. %or case studies of participatory research methodologies in the context of community development see Riano (1994), Nelson and Wright (1995) and Roe (1995). Baylies and Bujra (1995), Chasnoff (l9%), Guthrie et al (1996)and Schoepf (1995) have used participatory research methodologies with groups of women for sexvai health and HlV/AiDS eduation. contributed to the selection of a survey method. Finally, participatory methodologies are frequently prernised on sharing and disclosure on the researcher's part (Kirby and McKema, 1989;

Schrijvers, 1995). Zeller suggests researcher self-disclosure is patticularly important when researching sensitive topics (Zelier, 1993). My experience researching wornen's sexual histories validates this claim. However, the dficulty of separating my personal from professional Life in Anguilla, and my perception that it was necessary to maintain the appearance of confonning to particular sexual nonns in order to be accepted as a researcher and advocate for adolescent semai heaith made me hesitant to disclose my own sexual history. Educatiooal Elites, Development and the Lure of "Science" The education, regimented practices for producing "professional" knowledge, and the class interests of the elite in both the minority and majority world support reductionist science,I0 which in tum buttresses the hegemony of western/ northern models of modernization. One of the central claims of reductionist physicai and social sciences is that the knowledge produced is value- free or objective. In actuality, reductionist science is histoncally specific, ideologically driven and inextricably iinked with the advent and expansion of industrial capitalism. In and of itseK these are not critiques because all knowledge systems exist in context. However, reductionist science denies its context while negating the validity or denigrating the value of all other ways of knowing (Shiva, 1992). Dominant laiowledge systems render alternate knowledge systems untenable and irnpracticable by denying they exist and simultaneously undermining the conditions for their existence (Shiva, 1389; Shiva, 1993). The process described by Shiva was illustrated for me when an informant told me of a elderly Anguillian woman's difficulty finding "bush" (plants) used in traditionai healing. Economic growth spurred by tourism has provided materiai surplus to build and expand homes as well as creating more demand for housing among tourists and the lo~eductionis the process whereby concepts or statements that apply to one type of entity are redeîïned in terms of concepts, or analyzed in terms of statements, of another kind, normally one regarded as more basic. Accordhg to Shiva (1992) the ontological assumptions of reductionism are: a system is rcducible to its parts; al1 systems are made up of the same basic elements, which are discrete and atomistic; al1 systems have sidar, mechanical processes. The epistemological assumptions of reductionism are knowledge of the parts is equivalent to knowledge of the whole, and "experts"are the only legiiimate knowledge seekers and knowledge speakers. Reductionist science, which is the dominant scientific paradîgm currently operating, is science bat deploys these ontological and epistemological assumptions. immigrants drawn to the island to service these tourists. As a consequence, Anguilla's landscape is changing fiom "scrub" to concrete. This transformation has made it dficult to find certain plants for the "bush teas" that make up a large portion of Anguiila's indigenous pharmacology. At the same tirne, reification of modernity and modem medicine, which is also associated with economic and social change, creates a social wntext in which this healing knowledge is not valued by the younger generation. Thus, the impoverishment of a knowledge system, with the passing of the older generation and the loss of biodiversity, is portrayed as irrelevant (Field Notes, March 4, 1999). Methodologies associated with reductionist science claim to produce objective knowledge, and consequently decisions made using this knowledge claim to be neutral. The claim that decisions are value-fiee instead of serving the interests of particular social groups makes "modern" and "scientific" methods very attractive to the relatively powertùl (Avares, 1992;

Escobar, 1994; Shiva, 1992). Consequently, it is not surpriskg these methodologies hold sway in private and public institutions around the world. In my case, 1 received instruction fkom upper management to employ a research method that was quantifiable, reproducible, administered to a random sample and preferably analyzed using SPSS. When 1 suggested other research methods could provide greater insight into how young people understood their own sexuality, 1 was invited

to ask as many Anguiiiians as 1 chose for their opinions (Field Notes, September 5, 1998). The door was left open for me to explore other avenues of investigation, but the primacy of the pencil and paper survey was not negotiable. It was clear to me that intelligence gathered in formal or informa1 interviews was considered less valid and was less valued than responses transmuted through standardized questions and random sampling into an acceptable approximation of the truth. Or, in the terms we used "For the size of the population studied (932 students), the 154 surveys andyzed offers 99% confidence level" (Kendall, 1998a). The daim a "good research method," defined by the classic critena of random selection of participants and standardization, could produce a neutral description of the situation and that this supposed neutrdity outweighed other potential research results, such as detailed recounting of young people's own understanding of the conditions under which they f?mt had intercourse, was taken for granted by the men 1 worked for. While my employers seemed to accept the superiority of the survey method as "objective" and "scientific" unconsciously, the legitimacy they imputed to the information it wouid produce was perceived to offer strategic advantages locally and intemationdy. In the local conte-, the sexual attitudes and activity of adolescents was an extremety polarizing and sensitive issue. Appeal to the authority of a modem and objective research method was attractive to my supe~sorsbecause it allowed them to discuss "the facts". Discussing "the facts" provided the appearance of distance fkom the subject matter, reducing the stigma and political risk associated with speaking about or having an interest in sexuality. Producing idormation that adhered to criteria dictated by international fùnders was a goal of the research project. Professional formation in schools of public health and medicine had inculcated in my supe~sorsunquestioned acceptance of the validity of "neutral" and "objective" research rnethods. Dependence on the British Departrnent of Foreign and International Development and organizations such as the Pan American Health Organization for funding ensured continued adherence to these noms. The data produced was expected to assist the govenunent in securïng fùnds to solve "the problem" as descnbed by the data (Field Notes

January 6, 1999; Field Notes February 5, 1999). My relationship with my supenors and their relationship with international funders illustrates how: "The local level must reproduce the world as the top sees it" (Escobar, 1995, 11 1). The argument 1 found strongest for the paper and pencil methodology was the need for participants' anonymity in order to disclose any personal information. Perceived lack of confïdentiality and related dissatisfaction is a recumng theme in the literature on the Anguillian health care system (Carter-Davis, 1997; Kidd, 1997; Kendall, 1998a). The intensity of stigma associated with speaking about sexuality could only exacerbate this fear. The method chosen was appropriate in this respect, and procedures were established to maxhize participants' feeling of safety with respect to confïdentiality. The survey was self-adrninistered with sufncient space between the desks to prevent participants from viewing the responses of others. In the introductory explanation, 1 requested that the students respect each other's pnvacy and made sure students did not speak to each other during the survey administration. Youth and health service providers had expressexi a stmng conviction during the needs assessrnent that young people would feel more cornfortable disclosing their semai attitudes and practices to non-Anguillians. Youth said honest responses would be encouraged by not having any AnguiUian adults present during the survey administration. The survey was administered by myseifand another Canadian female volunteer. We were the oniy adults in the room while the young people compieted the survey. Instead of coiiecting the surveys, we had the audents deposit thern in a "ballot box" as they Iefi. "An Air Conditioned Otfice" 1 was given the only office with its own compter in Primary Health Care; the office signaled my status as a foreign expert who did not have a role in the day-to-day funetionhg of the health care system. The initiai reason given for me occupying this office was that it was my supervisor's, and as he would be away fiequently, we could share. When he was promoted and moved to another building, 1 was already established in his office and there 1 remained. In this sense, the space 1 occupied was a result of happenstance. On the other hand, my office space is an excellent metaphor for my location within the power structure. While the cornputer was extremely useh1 to me in my role as a "foreign expert" who created a statistical database and wrote papers, my positioning inside the hierarchy presented obstacles to the type of participatory research that 1 had envisioned. 1 reported directly to my supe~sorand was housed in his office, associating me with upper management instead of the health care workers. This association was deepened by the fact that, despite offering many tïmes, 1 was not given any work which pertained to the day-to-day fùnctioning of the health care system. 1 visited the heaith clinics and the secondary school but usually for scheduled meetings that tended to be with individuals in middle or upper management.

1 had iiited "natural" opportunities to interact with the people working on the fiont lines or to encourage their confidence and support by materially assisting them in their work. As 1 wasn't working on the front lines, daily contact with the people who used the seMces was also kted.

In an early fieId note, 1 wrote about:

... the feeling of isolation I how been given my own air-condirioned orne where Z close the door and am cul 08Especiaffy from fheyoungpeopfe and whafever they migh think At feast if1 cmld work beside the people I am trying to workfor, it would aifow me to blend and observe and maybe !O irndersfda bit beffer.As il is, I feei awkward meid mes, September 2, 1999) Designation as a researcher placed Limits on rny opportunities to become part of the furnitue, as it were.ll As the project progressed, 1 sought out and created occasions to increase my contact with young people; however, the decision to use a survey coincided with my initial entry period. The survey is a time-efficient method for researchers without organic relationships or contact with a population to coiiect information. The possibility for researchers to administer a survey through contacts in upper management and thus generate data without building relationships with the research participants undoubtedly contributes to the popularity of this method. On the other hand, the quality of analysis made without a relatively nuanced understanding of the local context and the self-understanding of the people who answered the questionnaire may be subject to cnticism. Self Disdosure Barriers to my own ability to be candid about myselfwith participants and barriers to faciiitating such disclosure among research participants, both central to transformative and participatory research processes, denved fiom the subject matter and the realities of small-island or small-town We. In the same way a pencil-and-paper survey provided confidentiality for the respondents, this method allowed me to access information about sexuality and reproduction without self-disclosure:

llOne might reasonably ask how a white woman couid be inconspicuous on an island that is mostly populated by descendants of black Africans. Whiie my color made me more immediately visible, it did not sœm to be of particular signincance. As a consequence of Anguilla's history, which is discussed in more detail in Chapter Two, race has not been an important category for detennining Mercnce. Thcre is no race hierarchy between white Anguillians and black An-. The most important distinction is made betwcen Anguiiiians and foreigners. Therefore, a white foreigner such as myseif and a black foreigner. such as someone fiom the Dominican Repubiic, tend to be constnicted by Angdiians as "non-AnguiIlians''rather than categorized based on skin color. Both black and white Anguillians participateci in the research and community consultations 1 undertook I am being drawn inîo a survey methodoiogy because it is easier, even though I don7 beiieve ir is the richest source of information. [...] Survey methodology doesn't demand real contact. Real contact is scary becarrse I need to be human and to be vuherable. In some way, a Stuvey is something for me to hide behind in my aircondtioned ofice,just like those lofy declarations of the LN Committee on this and that- (Field Notes, September 2, 1998) The risk associated with talking about sex was communicated to me in the initial youth focus group in which the young people described the prevdent homophobia on the island and told me that if anyone spoke about homosexuality or homophobia, they would be labeled as gay. They also told me that sexuality is not an issue that people would talk about. 1 perceived this discussion as a waming given to protect me fiom the ramifications of spe-gpubiicly about sexuality (Field Notes, August 19, 1998). Further experience on the island reinforced this early impression. 1 was told by the president of a non-governmental youth coalition that no one would talk about sexuality, especially women, because they would be seen as promiscuous or "bad" (Field Notes, October 28, 1999). A teacher who was very supportive of sexuality and AlDS prevention education encapsulated the assumption that people who spoke about sexuality were senially active and the associated stigxna when she said: "The way some of them talk, wdl, you know they're not innocent" (Field Notes, October 26, 1998). 1 was told by an admlliistrator in education that despite new protocols aliowing women who had children out of wedlock to continue teaching, such individuals would not be selected to teach about sexuality or reproduction even if they would be the "best" teachers in terms of their rapport with the students. The rational given was that such people have not demonstrated the correct moral values and are not credible (Field Notes, September 28, 1998).

1 felt that because 1 was a young, unmarried woman without children, disclosing my sexual history could have negative effects on my perceived legitimacy as a researcher and sexual health educator. According to the stated socid noms, because 1 was young and unrnarried, 1 should not have experiential knowledge of sexuality. The only knowledge that 1 could legitimately possess about sexuality was professional knowledge. 1 could retain my respectability, and associated status as an expert on sexuality, only by making my own sexuality invisible. In this situation, overcoming the expert/ non-expert divide through a process of mutual exchange and self-disclosure was perceived by me as a threat to my professional objectives as well as a considerable social risk. In previous research on sexuality 1 had experienced moments when conventional power relations, which position the researcher as the knower and the researched as the person to be known, were tumed topsy hirvy. No matter how non-judgmentally questions are fiamed, asking

people about their sexual practice suggests the person answering should have practiced safer sex, and the person asking the question has always done so. Disclosing to my research participants

transformed me fiom the safe sex promoter, who is assumed to be "sexuaüy liberated" and to have always practiced safer sex, into another woman with a story to teii. These exchanges mimicked the story telling 1 and the other women had experienced as a common facet of femaie tnendship. At times, my sudden transition fiom knower to known produced momentary discodort, but it was tolerable. These exchanges did away wit h the experthon-expert dichotomy and support ed deeper levels of disclosure and solidarity. In contrast, in the AnguiIlian context, even implications which could be drawn about my sexual mores or sexual history based on the fairly standard knowledge, attitudes, and practices survey 1 wrote were intimidating for me. 1 wrote in my field

I am scared to send my survey out to anyone because I am afiaid they wifl rhink it is inappropriate, thar I am a bud person, I guess. Thar is the fear. But heck, I don? know whar is culfuraliyappropriate and what isn't. So, I cun on& ask. I have to be brave enough to ask. (Field Notes, September 8, 1998) Chailenging norms in a gemeinschqfr or strong-tie community, such as Anguilla, is fkaught with risk. The conservative tendencies of small communities, which make changing norms difficult, arise not because aii people benefit f?om these norms equally or have the same interest, as some romantic conceptions of community suggest, but because violations of norms have consequences that cannot be evaded in the same way as in a larger, looser social grouping in an urban center:

.. .rural conservativism is not something which resides in the individual personaiities of people who live far fiom metropolitan centers. Rather, it is stmcturally deterrnïned by the many-stranded nature of the bonds that bind community members, and by the effectiveness and ubiquity of social sanctions operating against those who fail to confonn to cornmunity norms. The counselor well may be subject to the same sanctions... (Crago et al, 1996, 64). As weU as havuig a professional role in Anguilla, 1 was a resident. Any disclosure about my senial history would have impacts in ail spheres of my Me. Drawing a boundary between my professional life as a sema1 health researcher and my personal life was ni& impossible. UnWre cities where counselors, or other professionals, "cm live a private life that is separate fiom their work Me, those who operate in rural and remote areas are highly 'visible' to everyone....p osing massive problems of confidentiaiity and boundary maintenance" (Crago et ai, 1996, 61). Examples of unwanted visibility around sexuality could be things like purchasing condoms at the grocery store, having a pregnancy or HIV test, picking up a pamphlet about oral contraceptives in a clinic waiting room. AU of these events are open to observation, speculation and ultimately gossip and judgment about the sexual behavior and morality of the person who performs any of these acts. 1 was told many anecdotes which expressed the relationship between visibility, the tight bonds of a smali community and enforcing cornmunity norms. The fouowing story related to me is a good illustration of how visibility and rumor operate to ensure social nomand prevent disclosure of events that could provoke change. A young woman fiiend of an older married man arrived at his office in tears. To his questions about what was wrong, she replied with more tears before finally admitting that she had accepted a ride home fiom a neighbor, who had raped her. Despite her initiai refùsals, the older male fnend insisted she see a doctor and took her to the hospitai. A pregnancy test was taken and came back positive. Within two days, the nimor was circulating that the man who had driven the girl to the hospital was the father of the child. mer a few weeks, this individual was confionted by his wife, who had received a visit from women who attended the same church. Before two months were out, the pastor of the church paid a visit to the man in question and inquired about the incident. In the face of these rumors and accusations, the man could only proclaim his innocence. Meanwhile, the stos, of the rape was never told and charges were never laid against the rapist (Field Notes, September 5, 1998). The fact that the pregnancy was discussed and blame ailocated, but the rape remaineci invisible is indicative of how talk about teenage sexuality operated in Anguilia. Fear of censure prevented discussion of what had actually occurred, Ieaving nimors and innuendo to &date and ultirnately support the status quo. At moments 1 noticed 1 was ernploying the dominant social categories and morality of Anguilla (Field Notes, Decernber 4, 1998). Ultirnately, I beiieve 1 retained criticd distance from these social norms, however, 1 recognize the dominant paradigms in Anguilia inûuenced aspects of my thinking and that rny fears about social censure had effects on rny research methodology and my dissemination strategies. Crago raises an interesting point when he notes that the long- terrn residence that may be necessary to build trust and establish credibility in smaii communîties may also erode the ability of the counselor to resist local pressure to conform to "dysfiinctional" noms (Crago et al, 1996,62). Conservative tendencies, visibility and the associated pressure to conform to community norms are not a priori negative phenornena. However, in Anguilla, these tendencies presented challenges for undertaking a participatory research process, thus creating and supporting the maintenance of the status quo, which did not result in optimal reproductive and sexual health outcornes for Anguiilian adolescents. The stigma associated with speaking about sexuality creates difficult conditions to address discrepancies between sexual ideals and semai realities. Silence supports the status quo:

The fear of taking, inlernalizing is the probiem. The belief fhal abuse, infidelity is ymr faif traps you. It is the power of sharing eqerience thbrings people fogether tufighffor social change. (Fzeld Notes, October 18 1998) Despite my cornmitment to such sharing of experience, insecurity about under what conditions 1 would be considered a legitimate advocate for adolescent access to sexual and reproductive heaith services and education, and potential denial of contact with young people, discouraged me fkom undertaking a more participatory methodology. While 1 perceived the pnce for personal disclosure around sexuality as too high for me to be able to practice an extremely participatory methodology, rny experience of being someone who was not supposed to have a sexual Life according to stated Anguillian standards provided ïnsight into the dificulties young people faced in seeking information and seMces to support their reproductive and sexual heaith. The insights 1 gained fkom my own experience of living in Anguilla and the social networks 1 participated in iduenced my understanding of the sexual culture of Anguilia and the recommendations 1 made, which were ostensibly based on the survey data. A Participatory Survey Instrument While the major research method employed to investigate adolescent sexual and reprcductive health in Anguilla was a standard knowledge, attitudes, and practices survey, the needs assessment, development of the research instrument and dissemination of the findings incorporated participatory elements fiom a comrnunity development mode1 (British Columbia Mïnistry of Health and Ministry Responsible for Seniors, 1994). The National Adolescent Reproductive Health Survey was developed using the Pan American Health Organization's Caribbean Youth Health Survey @Blumet al, 1998) as a foundation and a standard Knowledge, Attitude, and Practice fiamework (Cleland and Ferry, 1995). Seven areas of interest were identified durhg the needs assessment. The areas identified were: contact with health services, channels of communication, knowledge about reproduction and HTV/AIDS, sexual behavior, perceptions of coniidentiality, condom readiness, and the socio-cultural implications of sexuality. A project proposal was written on the bais of the needs assessment and, with a draft version of the research instrument, circdated to al1 of the individual interviewees and some of the focus group participants. Feedback on the survey instrument was solicited and incorporated. The second version of the survey instrument was reviewed by a focus group of young people. To encourage the identification of issues absent fiom the survey, the youth completed a "brainstorm" around the important challenges facing adolescents with regards to sexual and reproductive health and considered what they would like to know about the sexual practices and attitudes of their peers before exarnining the survey instrument. The reason for having a brainstorm before young people comrnented on the survey was to provide a forum for the group to explore a wide variety of ideas without being iduenced by the lines of questioning in the survey. As a result of the focus group, questions were added and modified. Question sixty-five, which about when is "a good theto start having sex, " was a suggestion fiom the focus group. The question "Having many boyffiends/girlfiiends proves you are a real man or real wornan was modified to read "Having many girlfriends proves you are a real man," based on the youths' analysis of the sexual double standard. Initially, I had wanted to investigate whether having multiple partners had positive associations for young women as weli as for young men. However, the focus group stated categorically that multiple partners was not socialiy acceptable for women and therefore 1 changed the question for clarity. Perhaps the change made to this question is an illustration of the dangers of reproducing, rather than challenging, dominant assurnptions about

sexuality in health research and health promotion. l2

In addition to verifjing 1 was asking relevant questions, the focus group was an

opportunity to ensure the language of the survey would be understood by the respondents. l3 As much as possible, I wanted to use the colloquiai terms of Anguilla. The question "Have you had

sexual intercourse (done it, gone aii the way)?" was simplified to "have you had sex?" 1 was also able to elicit the AnguiIlian term for "making out." In rny own cultural context, "making out" denotes open-mouth kissing with tongues and touching of body parts, probabiy breasts and possibly genitals. I did not know how to express this type of semal experience in Anguillian terrns:

I had been asking mtd no oue could or woirlcl amer me. The term is 'yeelingirp. " Part of the reamn 1 hew it was right was the laughter of shockrecognition of the young people. To qxak in an "OJJiciaI"donrrnent, fike a survey... the woy youth acfzruliy~peak to each other is to dethe "tmfh," as experienced &yyouth, visible. I think it ispowerful und ernpowerirtg. Ir meuns the weyis about youth and their truth, (Field Notes, October 26, 1999) Using the language of youth and making the survey conform as closely as possible to youth perceptions of adolescent sexuality was an important goal. The finai stage of the survey preparation was a pre-test with eight randomly selected representatives tiom the second, third, fourth and fifth forms. The sixth forrn was excluded because it is an academic Stream for college preparation, which is not attained by the majority of

- - 12~oranalysis of the reproduction of dominant gender and sesual identities in health promotion about HIV/AIDS see Mq-rick ( 1996), especially pp. 41-76 and Wilton (1997). For more general analysis of the reproduction of dominant discourses about sdtyand sexval deMance through the mas media sec: Watney (1989), Williamson (1989) and Kitzinger (1993) for the UK; Emke (1991) and Sussel (1992) for Canada; Lupton (1994) for Ausiralia; and Juhasz (1995) for the United States. 13~ora dirussion of sexual tcrmùiology and question framing in Knowledge, Attitudes, Prafüce and Behaviour surveys of sexuality administercd in a variety of wuntries, see Cleland and Ferry (eds), 1995: 24-27. Anguillian secon- school students. The pre-test was carried out to ensure students at each form level could comprehend the survey and complete it within the dotted tirne. The success of the pre-test eased concerns 1 had about the literacy of the students and their ability to understand the survey. It ais0 resulted in more changes to the survey language. The question about "making out" had been phrased: Have you ever had any sexual experience (kissing, "feeling up")? Severai participants who answered "yes" crossed out "feeling up." 1 discussed the issue with two Anguifian male CO-workersin their mid-twenties. They toid me "feeling up" was "raw language" and asked why 1 had used the term. 1 explained that by semal experience 1 did not mean a chaste little goodnight kiss and told them in Canada we Say "French kissing." They agreed "French kissing" is a term used in Anguilla. We changed the final question to rad: "Have you had any sexual experience (French kissing, "feeling up")? (Field Notes, October 26, 1999). The process 1 went through to ver@ the relevance of the survey content and language was an important effort to make sure the data would be meaningftl. The survey administration and analysis were not participatory The survey was adrninistered to a randornly selected sample of one-hundred and sixty-three students. l4 Nine surveys were discarded because of logical inconsistencies or skipping of key sections.15 1 analyzed one-hundred and fïfty-four surveys using a statistics package designed for epidemiolcgy. Based on this analysis, 1 prepared a report and presented the findings and recornrnendations to community members in public meetings and through the mass media. 1 invited reactions, strategies, and participation in a multi-sectoral working group through these dissemination activities. These

14~representative proportion of students was selected from the second, third, fourth and fifth fom. Within each form, a simple random sample, in which any student was as likely as another student to be selected, was pcrformed. As schooling is mandatory in Anguilla, the randorn sample from these forms represents the knowledge, attitudes and practives of young people between hvclve and seventeen years. The sixrh form was excluded because thosc that continues ia the academic stream are a select population and not representative of the majority of seventeen-and-eighteen-yeateld Anguilhans. Parental permission wvas sought and obtained for al1 but two students. Teachers released the seiecied studcnts from classes to participate in the mey. For the six of the pulation ( 934 students) the number of respondents (154) ofïers a ninety-nine percent confidence level. example of a logical iaconsistency that would result in a questionnaire king discarded was il the respondent indicated thcy had never had sexual intercourse but went on to mark the contraceptive method they had used at last intercourse. If respondents skipped a whole section of the survey or did not complete the survey, their questionnaire was discarded. Logical inconsistencies and incomplete sumcys may be e-xplainedby low levels of comprehension related to difficulties reading or lack of interest on the part of thc respondent. The high percentage of meys which were kept indicates that the vast majority of the studcnts understood the survey questions and were interested enough to complete the wey. forums, particuiarly the Youth Consultation on Adolescent Sexual and Reproductive Health, permitted people to speak publicly about sexuality without being stigmatized. Responding to a report that framed the topic as a legitimate one for investigation and comrnenting on adolescent sexuality in general instead of personal terms were conditions in which dialogue was possible.

We1 recognize the pre-constructed and monologic aspects of a survey limits the extent to which participants cm ser-define and build trust, which provides conditions for change, the presentation of the survey data at public meetings provided a safe entxy point for dialogue.

Research Goals The research objectives stated in the proposal for the National Adolescent Reproductive

Health Survey, which 1wrote after two months on the istand, were to: assess the level of youth contact with health service providers; idente preferred channels of communication for sexual and reproductive health information; evduate knowledge of contraception, fertility and HIV transmission routes among students; gather baseline information about the sexuai practices of AnguiIlian young people; recognize barriers to help-seeking behaviors; appraise readiness for behavior change as it pertains to condom use; and provide insight into the context of senial activity (Kendali, 1998b). The fkst broad objective centered around providing a snapshot of the sexual knowledge, attitudes and practices of Anguillian young people to determine what reproductive and sexual health information and services were necessary. The second objective was to uncover existing barriers to youth accessing information and services and develop parameters for more effective education interventions and programs. The survey instrument and the report 1 wrote responded to these stated objectives.

Afker three months on the island, during the refinement of the survey instrument, 1 analyzed my position and objectives. At that point, 1 recognized the social stigma associated with researching sexuality but analyzed the relative social costs for me as lower than for an Anguillian

and bearable Field Notes, October 28, 1998). 1 recognized the survey methodoiogy presented difficulties for sustainability but was dlfocused on getting community members to recognize the adolescent sexual and reproductive health as an important issue: A@ I am gone, the ripples will smmth over the pond mid my pebble may be forever bu& Ir wdbe better ifpeople fiom rhe communiîy were direct& doing the survey, because the way their vision dered would becorne a facet of community lïJe and thus wmîld be sustairiable. On the other one of my goals in this survey is to provide information which can be the busis for communi~ dialogue. It is a maIl intennediary step towards giving people permission to talk about the issueddefine the issues. 111 a commrtltity development model, we are still at the stage of establzshing amortg the public that there is a problem. flield Notes, October 28, 1998)

The goal of simply getting the community to address issues of adolescent sexuality was altered as

1 analyzed the survey data and became more and more cognizant of the extent of mord panic. After I had analyzed the survey data and lived in Anguilla for five months, the unstated and overarching project goal, related to the stigmatizing effects of discussing sexuality and the discrepancy between the description of teenage pregnancy in the qualitative needs assessrnent and the actual trends in births to teenage mothers, was to provide informed opinion and opportunities for community dialogue that did not reinforce dominant constructions of adolescents and adolescent sexuality. During the consultation phase of the project, 1 consciously attempted to redefine the issue of teenage sexuality in two ways. In contrast to the dominant fianiing of adolescent sexuality as an insurmountable problem and sign of the cornmunity's moral decay, I wanted to present the issues as legitimate public hedth concerns to be addressed by the cornmunity. Second, înstead of constructing adolescents as morally compt individuals who were "problems," 1 argued for adolescents being essential participants in developing solutions. In order to achieve these goals, 1 took as many points of view as possible into consideration and consciously took the part of the young people. In this way, 1 opted to:

be an inteilectual intennediary in this transformational process, by trying to enter the perspectives and the interests of those for whom you have chosen within a given context. You interrogate yourself tirne and again: in whose interest do 1 rnake my choice of perspective out of the heterogeneous reality existing in the research situation, and how relevant is the acquired knowledge fiom their perspective? What possibilities do 1 have for returning the insights gained back to them? (Schrijvers, 1995,24-25) 1 identzed with youth because they were the most afTected and had the least voice in detennining the education and services they received about reproduction and sexuality. Limiteci contact with the youth, particularly those who were most marginalized, and fear of self-disclosure on both 39 sides, represented barriers to a truiy participatory process. 1 cannot clah to have heard a wide enough range of young people in enough depth to speak, if anyone ever can, on their behaif Instead, 1 was a strong advocate for young peoples' participation in the dialogue about their sexual and reproductive heafth needs and ways of meeting those needs. CHAPTER NO:A MORAL PANIC The needs assessment, which revealed a discrepancy between declinïng numbers of births to teenagers and vehement assertions that teenage pregnancies were increasing, was central for iiiuminating the moral panic about teenage sexuaiity occurring in Anguilla. However, the observation of the moral panic does not expiain why it is occumng. The social conditions that contribute to the moral panic and provide the context for addressing the issue of adolescent sexuaiity are embedded in Anguilla's unique history. Anguilla was isolated to a great extent fiom foreign cultural and economic forces fiom the mid-1800s until the early 1980s. The long period of isolation and rapid introduction to extemal economic and culturd forces has had two effects. First, the widely accepted narrative that Anguiila has been materidy impoverished partiaily explains why economic growth and associated trappings of modemity and professionalism have been embraced so fervently. Second, while aspects of econornic growth are welcomed, there is a great deai of tension about and resistance to "change." My perception of the tension between material modemity and social conservatism is reveded in this journal notation:

me apparent& modem nature of Angriilliari society is deceiving. Concrete houses, new cars and cornputers itr every oBce are just the mrfàce. Undemeath ruta a akep river of religiosiîy and moraliîy. (Field Notes, Septenber 12, 1998) In this tense atmosphere, the moral panic fùnctions to reaffirm social boundaries and social values, which are perceived to be threatened, while misrepresenting the issue it pretends to address and obscuring the deeper sources of social tension. Economic change in Anguiila has facilitated the introduction of new channels of communication, which challenge the hegemony of the traditional cultural leaders, the Christian organizations and the local politicians. The penetration of communication technologies bearing mediated images has changed the way Anguilla looks, particularly with regards to youth style. The dissemination of secular and scientific ideologies through the education of Anguiliian professionals overseas, arrivai of foreign consultants and invitation to participate in international development initiatives augment the profusion of competing discourses. Increased information, choice and diversiîy contribute to generating a sense of nsk and ambivalence, which is fertile ground for the growth of a moral panic. Tracing the history of Anguilla offers Uisight into changing economic and cultural conditions, which give rise to the social tension the moral panic channels. In addition, this historical view introduces and contextualizes some of the difFerent social actors who insert their narratives into the discourse on adolescent sexuality.

Beyond the Peripbery, 1650-1967

"In the sixties sometime, the Queen [of England] came to visit St. Kitts. And she asked to see Anma. And the people in St. Kitts, they took her to a piece of land cut off by barbed wire, with a dock. And they said: "That's Anguilla." (Field Notes, Discussion in an Anguillian Kitchen, August 6 1998)

As the AnguiIlians tel it, they asked Canada for aid money to build a pier. The money was sent to the central Government on St. Kitts, and the pier was budt- on St. Kitts. It was named Anguilla Pier.( Westlake, 1972, 28) The written history of Anguilla begins in 1609, when the British Captain Harcourt visited the island briefly and remarked: "1think never Englishrnen disembouged before us." In 1627, Charles 1 of England granted the Earl of Carlisle proprietary rights over al1 of the Caribbean, which included Anguilla. A permanent Enghsh settlement was established on the island in 1650 (Petty, 1991: 2). By the early eighteenth century the demographics and economy of the island changed because the English settlers reduced cultivation of tobacco and Cotton and imported

Afiican slaves in an effort to establish sugar plantations. l6 WhiIe these markers of the beginning of a colonial relationship are quite typical of the Caribbean, the subsequent economic and social history of Anguilla is unique because of the failure to establish a plantation economy. Intermittent and unreliable rainfàü, absence of streams or rivers to imgate, and generalîy poor soi1 made the plantation regime unfissible. Large landholders were unable to feed their slaves and released them three days a week to fmtheir own subsistence plots. The end of the apprenticeship system, which had bound former slaves as indentured labor, and extended droughts and famines from the early 1830s to the mid 1840s caused the cultivation of sugar to be almost completely abandoned. Most of the large landholders left Anguilla in search of more profitable ventures. Some less wealthy AnguiIlians also lefi the island; between 1837 and 1845, more than a 1,000 Anguihans

16~espitethe fact that sîavery was officiaiiy abolished within the United Kingdom in 1808, the 1821 Anguilh census records 365 whites, 327 fite blacks and 2388 slaves. Slavery in Anguilla actually came to an end in 1838, when the St, Kitts legislature abolished the apprenticeship system which had been instituted under the emancipalion act (Petty, 1991, 10-12; Cam and Petty, 1997,6 1-62). emigrated to other British colonies under various schemes by the British government to address the economic crisis in Anguilla and provide labor for sugar plantations elsewhere in their island colonies. However, the majority of Anguillians remained in Anguilla and became peasant farmers (Carty and Petty, 1997, 6 1-62; Edwards 1997,18; Petty, 1991, 1O- 12; Westlake, 1977,164 7). Anguilla was placed in a variety of colonial administrative units, but ditnculties extracting wealth fiom Anguilla Iessened the interest of colonial powers. Anguilla requested direct government by Bntain and material assistance fiom the early 1800s on but was essentially ignored on both counts. Instead, Anguilla was moved fiom one administrative unit to another without much thought for Anguillian interests. In 1671, the administration of the Leeward Island

Federation, which included Anguilla, was separated from Barbados (Petty, 1991, 3). In 18 16, the Leeward Island Federation was dissolved, and Anguilla was placed in an administrative unit with St. Kim, Nevis and the Crigin Islands. In 1822, Lord Bathhurst directed Govemor Maxwell to propose to the Assembly in St. Kitts to pass a law to enable a representative of Anguilla to sit in the Assembly. The Govemor responded that Anguilla should be governed directly fiom Britain, but this suggestion was rejected (Petty, 1991, 7-8). Frorn 1822 until 1958, locdy selected AnguiHian representatives made a variety of requests to the British crown to be politically separated tiom St. Kitts and govemed directly by Britain (Westlake, 1977, 19-25). These requests were ignored. Apart fiom the occasional funds directed to Anguilla for emergency relief or taxes levied at the infiequent moments when Anguilla achieved eaniings fiom cotton, salt and phosphate exports, the island's inhabitants were left to their own devices. Anguillians established a locaily elected government cailed the Veary in 1827, and permutations of this institution govemed Anguilla for the following one hundred and forty years (Petty, 199 1, 8-29). This period was characterized by neglect by the colonial power, acrimonious relations between St. Kitts and Anguilla, and a smaü local government with little ability to provide services to the population. The Limited literature available portrays the relations between Bntain, St. Kitts and Anguiila as a cause of physicai hardships for Anguillians. For example, during the 1930s and 1940s, British observers commented on the "poverty" of Anguillians. Anguilla's British

Administrator noted in 1930 that it was natural for Anguillians to feel their island was "the Cinderella of the three sister Islands" (Petty, 1991, 2 1). The 1945 Moyne Commission, established by Britain to study conditions in the British West Indies, was "irnpressed with the efforts of Anguillians to eke out a living in ditficult circumstances but appailed at the poor standards of housing and sanitation" (Petty, 1991,22-23). Later chroniclers concur. Westlake writes:

Pier, phones; the list goes on. No general electricity. Three- hundred-and-fifty children in a one-room school house. Less than a mile and a halfof paved road. Medical facilities that fkquently had operations performed by the light of a hurricane lamp and that gave hdsto transport a maximum of two emergency patients a year to an off island hospital. (Westlake, 1977, 28) Carty and Petty, two Anguillian historians, tel[ us: "Untii 1967 Anguilla remained relatively poor and underdeveloped, with no industries, no paved roads, no electricity, no pipe-borne water, no telephones and no proper port facilities. Health, sanitation and education were grossly inadequate"

(Carty and Petty, 1997, 65). While historical and contemporary commentators descnbe the situation of Anguilla prior to 1967 as a thne of physical hardship, some of the scant historical evidence suggests the econornic and social selfidetennination fostered by Anguilla's location beyond the periphery of the world system had some positive outcornes. The initial failure of the plantation regirne and subsequent neglect of Anguilla by the colonial power meant the island's economy and social institutions developed according to the principle of self-sufficiency. For exarnple, diflicult agricultural conditions made the ocean an essential food source and fishing required boats; Anguillians became boat builders and remain well known for this ski11 throughout the Caribbean. When slavery officially ended in the British-controlled islands in 1834, the social and economic structure of Anguilla was very different fiom sugar-producing islands of the Caribbean. St. Kitts and Anguilla are good foils because St. Kitts exemplifies the economic and social structures built under the plantation economy. Huge amounts of wealth were generated in St. Kitts through plantation agriculture. The econornic importance of the island during the colonial era is attested to by wven wars waged by the French and English for control of the island. St. Kitts was also an administrative center, ailowing privileged access to colonial capital and contact with the colonial powers. When slavery was abolished, weaith was concentrated with a srnail white minority, and the majority of the population became poor landless laborers, who continued to provide labor to the sugar plantations, which remained the economic backbone of the island. An economy based on sugar plantations and wide gaps between the nch and the poor continue to characterize St. Kitts in the late twentieth cenntry. In contrast, Anguilla developed as a poor petit-bourgeois society of small landholders, craftspeople and traders. Most Anguillian families, white and black, were small landholders with their own homes, plots of land, chickens and goats. The benefits of production oriented towards domestic consumption instead of export, relatively equal distribution of wealth and egalitarian social structure is üiustrated by a cornparison of population health indices for St. Kitts and Anguilla in 1938. At this tirne, the crude death rate was 13.6 per thousand in Anguilia as compared to 36.5 per thousand in St. Kitts, and the infant mortality rate was 77.7 per thousand in Anguilla as compared to 209.8 per thousand in St. Kitts (Petty, 1991,22). However, despite the fact that Anguilla may have actuaüy benefited fkom exclusion fiom the colonial system, the cultural narrative that Anguilla was poor and neglected and that the Anguillian Revolution was fought in large part to end poverty is a powerful explanation for the ways in which economic growth and modernization are embraced in Anguilla.

The Anguillian Revolution, 1967-1969 The end of both the benefits and disadvantages of isolation fiom the economic and social currents of the larger world system was signaled with the Anguillian revolution of 1967. The Anguillian Revolution was one of the oddest revolutions in history as it resulted in Anguiiia remaining a British Dependency, much to the ultimate satisfaction of Anguillians who had been petitioning to become a separate, sinde-island British colony since the 1820s. When faced with the looming threat of becorning independent of Bntain as part of the St. Kitts- Nevis- Anguilla Leeward Island Federation, Anguilla made a unilateral declaration of independence in 1967. Various representatives of the British Administration attempted to persuade Anguilla to accept govemance by St. Kitts, but the Anguillians remained obdurate. In 1969, the Anguillians expulsion of a British Junior Minister sent to establish an interim government resulted in an ignominious invasion by British forces. The Anguiilians refused to renege despite this show of force, and because the Anguiilian Revolution was essentially peaceful the occupying forces spent two years on the island building schools, paving roads, instituting an electrification program and studying the water table (Westlake, 1977, 263). Britain's role in assisting with AnguiUian infrastructure was established and has continued up to the current day.17 With the exception of some British aid money for infiastructure development, the decade

foliowing the revolution was characterized by the continuation of a subsistence economy and

persistence of systems of community cooperation (village help orjoI11~cation).In fact, an economy based mostly on the exchange of goods and seMces rather than money persisted in Anguilla until about 1980 (Edwards, 1997, 37). Changes in the economy were delayed by fears about the political fiiture and stability of Anguilla. Fears were laid to rest when the island was officiaiiy sepxated fiom St. Kitts and made a British Dependent Territory in 1980 (Field Notes, inte~ewwith Colville Petty, March 15, 1999). Anguilla's status as a Dependent Temtory governed directly by Britain irnproved Anguilla's access to hnds for infiastructure development. In addition to direct economic inputs, Anguilla's link to Britain encouraged investment by assuring

foreign interests the Anguillian political and econornic system was stable and accountable. Investrnent by Anguillians who had been living overseas and by foreigners began shortly &er Anguilia became a Dependent Temtory govemed directly by Bntain in 1980. Investment has been centered on towism.

Tourism and Economic Growth, 1984-1999 With the growth of the tourist industry in the 1980s, the climate and topography that had excluded or protected (depending on your perspective) Anguilla from the global economy made the island an attractive vacation destination. For those who can pay the price for "tranquillity wrapped in blue" (Anguilla Tourist Board, sign at Wallblake Airport), the island offers more than thirty lonely white sand beaches, cerulean waters, absence of jet skis and roving groups of cruise ship or package tourists, and arguably the best restaurants in the Caribbean. Anguilla's congruence

- 17~orexamplc, from August 1998-March 1999, whiie 1 was resident on Anguilia, a new police station and penitenhy, funded by îhe British, were cornpleted and the British govermuent pledged the necessary fun& for the construction of a middle school. The British Department of Foreign and Intcmational Development also provides technical assistance by providing consultants on ail areas of govemance and economic and social development with the tropical paradise fantasy is demonstrated and reinforced by the island's fiequent selection for high fashion photo shoots and as a location for a series of "abandoned on a tropical island" Mastercard advertisements. Madoma and Magic JOhnson are rumored to be muent visitors. Since the 1980s, tourism has been the engine of economic growth in Anguilia. The Anguillian census provides a good marker of the economic changes driven by tourism. The first comprehensive Anguiiiian census was taken in 1974, afler the landing strip was paved but before the completion of the first tourist hotel. Ten years later, the island's first five-star luxury resort opened, and a second census was taken. The most recent census was taken in 1992. The drop in the unemployment rate fiom 1974 to 1984 to 1992 demonstrates how tourism has driven economic growth. In 1974, forty percent of the population over fifteen who were able and wihg to work were unemployed. By 1984, only twenty-six percent were unemployed and by 1992, only seven percent (Statistical Unit, 1997, 28). The centrai role of tourism is illustrated by the contribution Anguilla's main exports (fish and lobster) rnake to the Gross Domestic Product relative to tourism. In 1986, crops, Livestock and fishing contributed just under six percent of the

GDP; by 1996, the contribution of these products had declined to just under four percent. By contrast, the contribution of the hospitaiity sector to the GDP varied fiom thirty-one to thirty- eight percent between 1986 and 1996. The money eamed in the tourist industry fùels consumption and supports "spin off' industries such as construction and wholesale and retail trade. Even though oniy a quarter of the economically active population was employed in a restaurant or a hotel in 1992, the eaniing and spending of this population supports the economy of Anguilla (Statistical Unit, 1992). Anguilia's transformation during the past fifteen years is striking. An island that historicdy subsisted on pigeon peas, yams, the hits of the sea and remittances from overseas family members is now peppered with gourmet restaurants that fly their fish in fiom Miami, fowl in fiom France and are fiequenred by a crowd "transported, a la Star Trek, fiom [one of ] the poshest watenng holes in Manhattan" (Immen, 1992). Between the beginning of the tourist era in

Anguilla (1 984-85) and 1992, the GDP per capita has increased two and a half times , fiom $753 1 Eastern Caribbean Douars ($28 10 USD) to $19,265 Eastern Caribbean Dollars ($71 88 USD). The cost of living has kept pace, though at a slightly slower rate (Statistical Unit, 1997). The saying that your needs adjust according to your income is relevant here. Anguillians may work as many or more hours to put food on the table, but the kind of work, where the table was made and who grew the food bas changed dramatically with the advent of the tourist industry. The dollars generated by tourîsm have transformed the rnajority of Anguillians f?om subsistence farmers and migrant laborers to government and service workers. The changes fkom the subsistence to a money economy dnven by tourïsm have been dramatic as illustrated by the government statistics about GDP and unemployment as well as by the visible transformation of the AnguiIlian landscape. However, 1 dont want to overstate the case. Anguillians still engage in subsistence activities, particularly fishg which do not appear in the Gross Domestic Product.

ïhere is still o strong community system bt which ifyou cm't pay for it. ii will be given to you. In partrpartrmlarthere is a local saying: '"As long as one man in Anguilla um fish, no one will go hungry. " (Field Notes, October 18, 1998) Growth, Nostalgia and Perception of Risk The Dependent Territory relationship makes Britain accountable for extemal affairs (such as security and international relations) and devolves daily governance of internai flairs to the locally elected Anguifian govenunent. However, the British legislature can legislate to bring AnguiIlian law in line with British standards. The occasions when this power has been exercised, such as changing legislation to permit teenage mothers to re-enter the education system, demonstrate the wide cultural divîde between the secular, humanist ethic accepted in Britain and the interpretation of God's word, which continues to hold sway in Anguilla. While the economic benefits brought by the colonial relationship are embraced, the so-cded modernization of Anguilla's laws is not. In this case, the change agent is clearly identified and disliked even ifit cannot be rejected without jeopardinng Anguilla's econornic well being. However, more diffuse cultural coloniaiism, such as the spread of the private automobile or cable television and the lifestyle changes which accompany these consumer goods are embraced.18 The slightly

I8T'he infrastucture praiseû and promised by local politicians has dramatic effecu on the material and cultural conditions in Anguilla. Road building and paving are an important devclopment goal and campaign promise because cars are a national obsession, In the pst, the first investment by young people would go towards a home; schizophrenic retationship with economic growth is critical for understanding why a discourse concerned with the perceived moral decay of Anguilla has arisen. On one hd,the population who elects the government, the local politicians, and the bureaucrats eagerly embrace increased infiastructure and the perceived benefits of modemkation. On the other hand, change has produced anxiety. Contrasting statements made by Anguilla's political leadership during the 1999 election campaign and on the twenty-fifth anniversary of the Anguifian Revolution in 1993

provide an illustration of the contradictions. The simultaneous race for economic growth and nostalgia for the past as a moral mode1 provides an atmosphere of risk, demanding a scapegoat or moral panic. A group of youth are cast as deviants, and the very potiticians and leading citizens who encourage economic change take up the mande of the "moral entrepreneurs" who wiil guide the society back to the safety of traditional moral values.19 The 1999 Anguillian election campaign provided an excellent opportunity to take the pulse of the island. Debates over the best ways to promote economic growth in Anguilla domînated the election; the primacy of economic growth as an objective was not questioned. In inte~ewsand at public railies, politicians grounded their campaigns in proofs of or promises for improved infiastructure. The victorious candidates claimed modernity expressed by matenal development, in the 1990s, yowig people are just as likely to mortgage their family land to put a downpayment on a car (Field Notes, interview with youth worker, August 25, 1998; Hoâge. 1998). The number of pnvate vehicles on the island has kept pace with the growth in GDP, not the growth of population. In 1986, there were 1647 vehicles for a population of aproximately 4500 people; in 1993, 2882 private vchicles for 8%0 people. This is appro-simatelyone car for every three people, not including hired cars such as tasis chat also provide uansportation for family and fricnds. in 1992,65% of households rcported owning at least one vehicie, and in wealthier families every fdy member may have a vehicle. In total in 1996. there were 4289 vehicles registered in Anguilla, which represents a car demi@ of a little more than forty-seven vehiclcs per square kilomeire and almost one car for every two people (Statisticai Unit, 1997). 1 perceived Anguilla to have an important car culture. Cars have changed the pace of life by altering AnguiIlians relationship with the natural world. Foucault discusses the indwtriabation of time and how the bodies of former peasants turned labourers are disciplined under a regime of bells, whisîies and time clocks when they cnter the factory. The cycles of work and rest dictated by the seasons were transformai into a uniform work week as part of the industrial revolution (Foucault, 1979: 149-177). 1 observed a similiar phenornenon in Anguilla with respect to the rain. Prior to the mass arrivai of cars in Anguilla, peoplc walked where they had to go. if it was raining, people stayed home. The car makes travel more cornfortable on rainy days and is creating an expectation that people will comc to work and school when it is raining. Absenteeism continues to be higher on rainy days, but people do corne and e.upress their nostalgia through frequent sighs of "Today is a good day to be home sleeping." Attendance when it is minhg is part of the process of rofessionalization and modemkation of the AnguiHian workforce. P%oraI entrepeneun is Cohenk term for the politicians, Church leaders and media pundits who step fo-d as representative of "traditionai values" and thereby profit from the scapcgoating of marguialized groups (Cohen, 1972). such as infiastructure, as their main theme. Albert Hughes, the victonous incumbent in West End stated, "The reason for the Anguilla Revolution was to get such basic needs as water, electricity, telephones and proper roads" (The Anguillia~z,February 19, 1999). 1 attended a public rally for another successfbi candidate in which ali of the speakers praised and promised modemiîy in the form of paved roads, water system and a professionalized civil service (Field Notes, February 18, 1999). The party that won three of the available seven seats and formed a coalition governrnent asked Anguilla to "Stay on Tirne" and promised to: "focus attention on social economic planning and promote proper management of our econornic resources ...for diversification of industry as a means for faster economic growth." The party's leader had been Finance Minister in the previous government, and the election brochure iiiustrated the benefits of "econornic growth" during his tenure with numerous photographs20 throughout the brochure (Anguilla Democratic Party, 1999). Material gains were offered as proof of what the party has done for Anguilla and a promise for the fùture. The sarne polïticians and leaders who vaunted and encouraged econornic development marked the twenty-fifth anniversary of the Anguillian revolution with condemnations of social change. Fabian Fahie, a long-time administrator in the Anguiilian governrnent, outlined:

"the social costs of deveIopment reflected and to be reflected in the deciine of moral values and traditional customs ... The Anguillians who passed on in the 1960s would be amazed at the Anguilla of today, at the physicai changes. But perhaps they would be just as amazed at the disappearance of those traditional values which make us Anguiliian and which money cannot buy (Fahie, 1992, 12). Hubert Hughes, who was etected for a second tenn as Chief Minister in 1999, stated, "Looking back over the last twenty-five years 1 am bewildered by the lack of community goodwill, the decay of ethical and moral value; the disrespect for good manners and respect for the elderly and

20~hotographsof: New Jetty at The Cove; Pipelines at Shoal Bay; Jctty at Island mur,Asphalt Road at West End; Customs Cargo Warehouse at Wallblake Arrport; Maternity Suite at PrYicess Alexandta Hospital; Guard Rail at Sandy Ground; Guard Rail at Back Street; Basketbal1 Court at Soutli Hill; Hurricane Luis relief homes; Site for watcr desalination; New Office for Water Department; AspMt Plant; Court House and Parliamentary Building; Elliot Carty Road at Sandy Ground; New Lab at the Princess AIc.sandra Hospital; New Police Station; Playing Field at Sandy Ground; Ronald Webster Park Photographs were an excellent communication tool because they are very ancrete and comprehensible to members of the population who are not literate. OBticial rates of literacy for Anguilla are 96% (Ministxy of Social Senices and Lands, 1998), but teachers and other service providers estirnateci the rates of literacy in terms of king able to rcad and write as closer to 6û%. Rates of Literacy are lower among those over thirty. for the growth of the alien values of matenaLism"(Hughes, 1992, 16).Victor Banks, leader of the Anguilla Democratic Party, elected for a second term in March 1999, took the occasion to comment on the destruction of the "communal family" and note that in a "modem society both parents must work if they are to aord al1 the things they consider necessities. The pressure of this family environment both on children and parents have led to rnany abuses and incidents of violence within the fdy"(Banks, 1992, 19). The "loss of traditional values" and "decay of moral and ethical values" is linked with the destruction of the family in this narrative. Fear about change is articulated primarily as an assertion that Anguilla is changing fiom a Christian to a secular society. The specter of secularization calls forth mord entrepreneurs bent on "rescuing society fiom spiritual decay and moral collapse, thus restoring strength and righteousness in our nation" (Anguilla Christian Men's Association, 1999). Destruction of the family, and specifically increased teenage pregnancy, are held up as examples of moral decay. The description of teenage semality as the threat to Christian values is not random. Organized Christianity and the reîigious and political public figures who clairn to speak on its behalfand in its defense are the traditional power brokers in Anguillian society. Christianity has been and continues to be the central institution of Anguillian society. Therefore, a threat to Christian values is perceived as a generd nsk. If Anguilla's churches are supposed to represent Anguilla's past, the young people attending secondary school in the late 1990s provide a potent symbol for Anguilla's present. The adolescents of the 1990s are the first generation to grow up in the wage economy.

Unlike AnguiIlians a mere decade older, the childhood of the adolescents of the late 1990s was characterized by Black Entertainment Television and fiozen chicken imported fiom America rather than evening broadcasts of Anguilla Radio and subsistence agriculture. It easy for moral entrepeneurs to construct these young people as a symbol of change. Christianity and Cable Christianity began as and remains the pre-eminent social institution in Anguilla. Presumably, when the first English settlers anived in 1650, they brought the Church of England with them. The two first denominations to arrive on Anguilla continue to have the largest corigregations. Among the de jure population of the 1992 census; 8960 (ninety-three percent) expressed some religious atnliation: 3207 Anglican; 2648 Methodist; 6 13 Seventh Day Adventist;

628 Baptia; 503 Catholic; 351 Church of God Prophecy; and 1010 Other21 (Statistical Unit, 1992). The importance of churches in Anguilla caused a local educator to assert that in Anguilla, "comrnunity" refers to the village where people are of the same social standing, Myorientation and religion" (Edwards, 1997, 18). Churches provide the foundation for the social networks; there are few secular organs of civil society. For example, the Anguilla National Women's Councii is a federation of representatives fiom the various churches. Likewise, the majonty of organizational members of the Anguilla National Youth Council are church youth groups. Youth organizations such as Girl Guides, Boy Scouts and Pathfinders are respectively associated with the Methodist and Seventh Day Adventist Churches. Congruent with the 1992 census in which only seven percent of the respondents did not indicate a religious affüiation, only eleven percent of the young people who participated in the National Adolescent Reproductive Health Survey reported no church attendance. Forty-two percent of young people reported spending between three and fifteen hours in church-based activities on a weekiy basis (Kendaii, 1998% 3). For most Anguiilians of al1 ages, organized religion, pnmarily Christianity, is an important social institution. The centrality of the churches and role of Christianity in legitimizing leaders is demonstrated in that interventions in the public sphere, whether cornrnents in public debates or editorials and statements published in the local newspaper, are fiarned in a Christian idiom. The fiont page of The Anguiffimon Friday February 12, 1999 provided two excelient examples. One story announced the dissolution of the House of Assembly and upcoming general elections under the biblically inspireci title: "Judgrnent Day"; "candidates will be vying for election in the various

21~rommy field observations, 1 wnclude mon of the Yhher" category would belong to evangelical Protestant churches not specined in the census, howevcr there are also Rastaf,?rians and Muslims in Anguila constituencies on March 4. Judgment Day has been set." A second story titled "Court seeks divine help" reports the opening of the Eastern Caribbean Supreme Court with a church service. Another example of the invocation of "God's law" and construction of Anguilla as a Christian society was the füror provoked by the presentation of a White Paper by British Foreign Secretary Robin Cook on March 17, 1999. The White Paper advised "overseas territones" to outlaw corporal punishment and Iegalize homosemal acts between consenting adults voluntarily before Britain intervened to bring Anguillian Law into concordance with British Law. In a fiont-page story titled: "United against Homosexuaiity," the papefs editor asserted:

"on the question of Iegalizing homosexuaiity, however, the Govenunent, Church and the citizenry of the island stand united against this requirement by Britain. Chief Minister Hubert Hughes is vehemently opposed to this demand and Leader of the Opposition Osbourne Fleming is supporting his stand saying [..-.]: "1 know the people of Anguilla will have no part of this. We are stnctly against this kind of behavior. We are a God-fearing people. The Bible is the guide by which we live" ("United Against Homosexuaiity," 1999). In this narrative, God's Law is hegemonic; political foes, the state, the churches, and the population are ali united in obedience to biblical ordinations about se~uality.~~The continueci strength of the Christian values espoused in Anguilla is a testimony to the historical importance of religiocs organizations. Churches have been and in many senses continue to be the primary institutions that provide political and moral guidance as well as social services. The hegemony of religious organhtions only began to be challenged dunng the 1980s with the influx of foreign socialking forces such as tourists and electronic media. The penetration of communication technologies hto AnguiIlian households was as rapid as the econornic growth which enwuraged access. The 1974 census does not record presence of consumer durables in households but does reveal that only ten percent of households had

22~heconstruction of the reader as "god feaiing" and heteroseml is a common strategy. Withh a ansensus- building media "e.xactiy whose 'society' is being threatened is not open to question, since the consensual mode1 requires 'society' to be everyone. Dissidents, then, are mad or malicious" (Hartley, 1982: 84). The form of address and assumed audience for mainstrearn reporthg on HIV/AiDS bas reproduçed dominant modes of thinking about "us"(heterosexvals who have sex in the missionary position and couldn't possibly wntrad a sexually transmitied disease) and "them" (homosexuals, prostitutes, intravenous dnig users and assortcd others). The audience assumed for HN/AiDS stories in the mainstream media tend to be heter0se.d and HIV negative (Gros, 1984, 138; Juhasz, 1995,9). electricity. By 1984, sixty-four percent of Anguillian households had electricity, eighty-seven

percent had a radio and fifty-three percent had a television. The 1992 census recorded that ninety percent of households had electricity and eighty percent had a teIevision set. Cable television ascended in a sunilarly rapid fashion- An Anguillian, Cuthwin Webster,

introduced limited cable seMce on the island in 1988. By 1990 when he sold out to the foreign- owned Ail Island Cable, there were 150 cable customers. In the next three years, subscription increased almost one-hundred fold.

Figure 2: Cable Su bscribers, 19934998

cabk subrcribers

With the exception of 1995 when Humcane Luis interrupted cable television's inexorable

penetration, the number of subscribers has increased steadily (AU Island Cable, 1999). Aüowing a ten percent increase in the number of households on Anguilla between 1992 and 1998 and assuming that aîi tourist accommodation had cable, sixty-seven percent of Anguillian households would have cable television.23 In tess than a decade, satellite television has become a ubiquitous feature of Anguiliian We.

23~umberof Hourholds 26 19 plus lOO/o=288 1.2800 cable subscribers minus aii tourkt ammodation 866 rmms = 1934 cable subscriïrs (Statistical Unit, 1992 and 1997). Radio and television have exposed Anguillians to a wide variety of popular culîure, much of which varies fiom the biblically rooted worldview which has traditionaily held sway on the island. The images and noms of other locales and peoples are consurned daiiy on Anguillia. Ln particular, Anguillian youth demonstrated a strong preference for foreign content in both their radio Listening and television viewing. The most popular radio station among secondary students was 94.7 FM St. Martin which plays some soca2" but is dominated by American pop and R&B. The popular music station of Anguilla which plays prirnarily soca, with a focus on regional bands, came a rather distant second in popularity. Young people watch Amencan television programs almost exclusively. More than seventy percent of young people reported "rarely or nevert' watching three of the four local or regionaily produced television programs: the Chief Minister's Address (seventy-seven percent no); Caribscope (seventy-three percent no); and Caribusiness (seventy-eight percent no). One of the programs, a thirty-minute magazine about Anguilia aired once a week, Anguilla Diary, captured more youth viewers; eleven percent reported watching often and forty-five percent reported watchuig sometimes. However, Channef Three, "the island information channel" on which these local and regionai shows are aired was not selected as one of the favorite television stations by even one of the one-hundred-and-f3y-fourrespondents. Four charnels captured sixty-two percent of the youth audience: Chicago Superstation ten percent; USA Network seventeen percent; HBO pay-per-view eleven percent; and Black Entertainment Television twenty-four percent (Kendall, 1998a). The rapid econornic change Anguilla has experienced and the challenge to the dominance of traditional culturai leaders offered by the penetration of new communication technologies provide the conditions of instability and motivation for moral entrepeneurship, which typically predicate the emergence of a moral panic. The current adolescents' position as the fira generation to be raised within a new economic system helps to explain but does not Myexplicate why adolescent sexuality has emerged as a foik demon. In addition to their position as a signifier of change, the highly visible phenornenon of AnguiIlian youth appropriating global culture, the

24~ocais the pop or dance music of the Caribbean that first appeared in the laie 1970s. The musical form deriws fiom calypso but unlike calypso, which has a strong focus on lyrical content and associateci political rneaning, soca is mosüy concerned wiui partying and sex (Manuel et al., 1995: 193-194). liminality of adolescence and the highly charged social nexus of sexuality wntribute to the construction of a crisis around teenage pregnancy. Youth Visibility Cohen posited a relationship between the social and economic conditions in post-war Britain and the moral panic about Mods and Rockers. In the post war era, Britain was co&onted with the twin themes of newly acquired affluence and the emergence of a consumerist youth culture (Cohen, 1972, 192). Increased wealth and a demographic bulge of young people, whose newly acquired trappings seemed to demarcate them fiom the values of their parents, was eerily echoed in the British dependency of Anguilla in the late 1990s. ifglorifjing the brand names and fashion statements associateci with black Amencan urban youth culture is taken as a marker of how young people are incorporating foreign elements into the construction of their own identities, it is clear hip hop has arrived in Anguilla with a vengeance. One embodiment of consumerism and fetishization of brand names was the practice of young men to have logos shaved into their hair, 1 watched paralyzed with horror and enchanted with the metaphor of my barber carving a Nike swoop on the back of a thirteen year boy's skull. Jailing (wearing pants low on the hip in an imitation of penitentiary inmates who are denied belts) was much in evidence (Field Notes, November 24, 1998). WMe Anguillian youth undoubtedly rework the sip.dication of these stock icons of global youth culture in their appropriations, that the icons finction as a signifier of

"other" and "difTerentUfiom the older generation cannot be denied. The outré dserence of youth style culture pushes youth forward as a target for a moral panic: "The manipulation of appropriate symbols- the process which sustains moral campaigns, panics and crusades- is made much easier when the object of attack is both highly visible and stmcturally weak" (Cohen, 1972, 198). Whether they were scooter driving, anorak wearing youth at the English seaside in the 1960s or boys in baggy pants, hi@ tops and gold chains, crowded around a car parked under a tamarind tree, blasting rap in Anguilla in the 1990s, youth are almost by definition highly visible to addts. Youth culture demarcates and exaggerates the generational divide, providing a fùlcrum for the moral panic. Sexual Boundary Zones Moral panics are about drawing and re-drawing social boundaries, and, therefore, adolescence and sexuality provide compeliing demons to be exorcised or contained. Adolescence is in itseif a boundary crossing between childhood and adulthood, causing youth to be "regarded as both at risk and a source of risk ...it is the very marginality and ambiguity of status that exacerbates the risks associated with youth. Youth presents a problem for social regulation and the reproduction of the social order" (Thompson, 1998,41). Youth sexuality amplifies the disturbing ambiguity of adolescence (Nathanson, 1991, 7-50). Fust sexual intercourse and the attendant possibility of reproduction are key demarcations between childhood and adulthood. Of d the social boundaries to be negotiated in adolescence, sexuality is among the most highiy charged :

It [sexuality] appears rather as an especially dense transfer point for relations of power: between men and women, young people and old people, parents and offspring, teachers and midents, pnests and laity, and administration and a population. Sexuaiity is not the most intractable element in power relations, but rather one of those endowed with the greatest instrumentaiity: usefiil for the greatest nurnber of maneuvers and capable of seMng as a point of support, as a linchpin, for the most varied strategies. (Foucault, 1978, 103) Cultures have taken great pains to construct elaborate rules and roles around first intercourse and reproduction. The Christian tradition insists on the value of abstinence until mamage and childbea~gwithin marriage. In a society such as Anguilla, in which the hegemonic self-definition is Christian, the evident tramgression represented by teenage pregnancy is easily mobilized as a sign of moral decay. Signification Spirai During a moral panic, the actions of those who are labeled deviant are perceived to be a nsk or a threat which symbolize a larger (negative) change in society. Cohen refers to this process as "It's Not Only This." Building on Cohen's work, Stuart Hall and the Birmingham School describe a "signification spiral," which is a process of describing and linking stereotypes already in the reaim of ideas to each other: "the net effect is amplification, not in the real events being described but in their threat potential for society" ( Hall et al cited in Thompson, 1998: 66). The following statement by Colville Petty in his weekly full-page editorial in The AnguiIlian demonstrates how materialism and the arrival of alternative cultural channels (television) have been symbolically interwoven with lack of respect for authority (evidenced by "bad manners" and disrespect to "elders") and the breakdown of the fainily unit, which is perceived to encourage youth promiscuity, drug and alcohol use, and teenage pregnancy. Ultimately, these putative phenomenon are fiameci to signal the arrival of a secular, non-Christian society:

There is no doubt that Anguillian society is in decay. The evidence is ail around us: gang violence, drug abuse and the many other social ills. Evidence of this decay can be seen in the nun-swollen faces of some of our young men who walk Our streets dnink. It can be seen in some of our young men who appear dazed fiom drugs and walk as though they are stepping on a bed of nails. It can be seen in the increasing number of children who are making children. It was Campbell Fleming who once said [1977] that "ifmothers trained their girls the way they should be trained, ali the young men in the world could come to Anguilla and there would be no immoral acts. [...] In the craving for matenal wealth we lost sight of that fiindamental de25 and of our roles as parents. We neglected Our duties, abandoned Our children and aliowed the television to breast-feed them with violence and other vices. (Petty, 1999) The sigdication spiral bctions so that only one or two of these perceived phenomenon need to be mentioned in order to invoke the others. The absorption of these linkages was highhghted for me when 1 asked a group of peer counselors to outline priority areas for their friture training sessions. Teenage pregnancy was mentioned in the same breath as promiscuity, which was equated with premaritai sex and associated with substance abuse. When 1 asked about the relationship between premarital sex, promiscuity and substance abuse, 1 was told: "Premuritalsex is promiscuity, and people who are promisamus drit~kand do drirgs - Ihey go togetheru(Field Notes, December 3, 1998). Alcohol and dnig consumption have indeed been linked to increased sexual risk-taking behavior. For example, a nurnber of studies have found American heterosexual college students who fiequentiy combïned alcohol use and sex were less likely to use condoms (Scanlan, 1997, 18). However, in this case, the assertion was not simply that drinking can disinhibit people and encourage risk taking, but that the type of people who dnnk and use dmgs are sexually promisnious. The association hinges on the moral character of the individuals. It is

- - 25~enyis making reference to the saying: "Vain up a child in the way he should go [so that] when he is old he shali not depart from it" interesthg to note that whiie the young women I was speaking with were two of the school's top students, they took promiscuity to Iiteraiiy mean pre-marital sex instead of sex with rnany partners. In the signincation spiral which functioned dunng Anguilla's moral panic of the late 199Os, teenage pregnancy becarne simultaneously representative of the change occurring in Anguilla and a threat to the "true" nature of Anguillian society. The contradictions between Christianity and the dominant familial patterns in the Caribbean are not new. In the English-speaking Caribbean, multiple consecutive partners for men is the norm, as is a succession of single partners for women (Allen; 1997, 201 ; Cox, 1997, 3 86; Senior, 1991, 171- 173). In Anguiila, the pattern of births and fdystructure was explained to me in various ways with the same results: " rhen Mr. X cornes along and rhen you have buby riumber two " (Field Notes, August 12, 1999) or "hedot ft give nothingfor fiee, if he going to tuke care of rhat one, he wunt one ofhis own" (Field Notes, Aupst 20, 1998). Senior states that in the Caribbean generaily, fifty percent of women begin childbearing as teenagers, only twenty- five percent of ctiildren are bom into nuclear families, and fi@ percent of households are headed by women (Senior, 199 1, 8- 10). The irony of the moral panic is that, in Anguilla, iiiegitimacy rates are stable and births to teenage mothers have declined dramaticaiiy and steadily since the late 1970s ( Kendall, 1998b; Statistical Unit, 1996, 6). The moral panic about teenage pregnancy is not new either: "Sometimes the object of the panic is quite noveI and at other times it is something which has been in existence long enough, but suddenly appears in the limelight"(Cohen, 1972,9). In the Caribbean context, the construction of early sexual activity, premarital semai activity and the resulting births as a problem has a venerable limage. Missionaries, succeeded by governor's wives, and more recently public health departments and international development organizations have al1 raised concern about the large numbers of young unrnarried mothers and fernale headed households which characterize farnily life in the Caribbean (Massiah, 1983; Senior, 1991). The importance of the issue to "developers" is typified in a United Nations Family Planning Association technical report fiom the mid-eighties, which states: "teenage pregnancies have [thus] become the major and most urgent problem in the Caribbean" (UNFPA, 1984, 7). In fact, international development in the form of family planning arrived in Anguilla as early as 1979, when the United Nations Family Planning Association and Pan American Health Organization buiIt the infiastructure for a famiIy life education center and trained and subsidized the employees (UNFPA, 1984). Yet, despite the moral entrepreneurs in the region decrying teenage pregnancy for hundreds of years, the low tendency to marry, high incidence of eariy pregnancy, female-headed households and illegitimacy has been most resisîant to the economic, political and social changes, which have transfod other aspects of Caribbean society since emancipation (Senior, 199 1, 82-82). Constructing teenage pregnancy as a new cnsis when births to teenage mothers are declining and marriage and illegitimacy rates are stable seems like a non-sequitur. However, a moral panic is not about logic but about reducing anxiety about perceived instability. How teenage pregnancy becomes targeted as a sign of the breakdown of society amid contradictions between Caribbean fady structure and Christian expectations is suggested by the following observation made by a man who was quite typical of the up-and-coming Anguillian middle cla~s:~~

Hz also talked about the pasi of Anguilla and how he 's struggied: raised by an amt becuuse his morher was in St. Martin workitig, father spiit for E11gIand, no running water, piaying school [sicJ Yet wheti he tafksabout the breakdm of society, he invokes single motherhd as ifpromiscuity was a new causaifactor. Furthemore. he insists on his identity as a boni again Chnsriun and his serual fidelity to his wije but boasts about becoming semraliiy active at huelve, before he was "saved " Iibe story of his eady promisarity seems important to his iderrtity as an AnguiIliun man jusî as his assertion of acrrenl motjogarny seems important to his identity as a Christian. (FefdNotes, Augl~st4, 1998) The Christian code, which is held up as the ideal; other discourses of sexuality, masculinity and femininity; and actual practice have a long history of contradiction in the Ca.~-ibbean.*~Conditions of rapid economic change and infusion of new social role models challenge traditional cultural values and provide the impetus for identwng adolescents, especially pregnant adolescents, as the cause of social anxiety. The labeling marks the individual or, in this case, adolescents as a group, as deviant and holds them morally responsible as individuals. The process avoids acknowledging

26~ehad a job in the public seclor and was moonlighting in the private sector, while his wife worked in the tourist industxy. They had several children, owned their own home and posscssed al1 kinds of consumer durables, including two cars. 27~eniormmments that the majority of men and women in the Caribbean have never been able to reaiize the social gender and sex role expectations (Senior, 199 1,4 1). either the root causes of the arYriety or the social phenornena that are contributhg to teenage pregnancies. The solution put forward by the moral entrepreneurs in a moral panic is a simplistic rem to traditional values. The foiiowing observation is about the attitudes towaïds and solutions proposed for women who are in abusive domestic relationships and, thus, does not pertah specificaiiy to teenage pregnancy. However, the quote clearly illustrates the refùsai to examine the phenornenon, blaming the victim, and calling for a retum to "Christian values," al1 of which characterize the moral panic:

The attitude seems to be one of biame: "ir is her own stupid fmft ifshe married him just tu get that ring on herjittger, so ~owshe'if hm to deal with it [abusel." [A highly placed wornan in the Angicillht women 's movetnent] gave the closhg "thanks"by sayihg: 'meproblern [wife abuse] is a remit of the loss ofjamiily values. menI was growing up, we ail went to church. ifwe affjust went back to church everything wouid be OK because good Christians wmfcitt't beut their wives. " (Field Notes, November 2 7, 1998) Just as women who are being beaten are blamed and expected to live with or resolve theu difficulties with their partners, teenage mothers are blamed for their situation and expected to rise above it. Teenage mothers get little sympathy, though there is sympathy expressed for the children, who aren't being raised "properly" (women's focus group, August 20, 1999). The objects of the moral panic provide an escape valve for social pressure without addressing the true cause of the anxiety. The moral panic also provides the appearance of social cohesion among "al1 good upstanding citizens" by advocating a retum to traditional values. The solutions offered in the moral panic are not based on an examination of the issues they pretend to address and, therefore, cannot be usefùl for the purpose of addressing the purported object of the panic. Instead, the moral panic functions to simultaneously obfùscate the sources of social anxiety, such as rapid socio-econornic change, and maintain the status quo. Conclusion Grasping Anguilla's extended econornic and cultural isolation followed by the mercurial rise to relative afnuence based on tourism is crucial for understanding the moral panic that arose around teenage pregnancy in the late 1990s. The challenge to the hegemonic biblical worldview, which has dorninated the AnguiUian public sphere, provoked traditional cultural authorities, both religious leaders and politicians, to take on the mantle of moral entrepreneurs. Whiie leaders embraced economzc growth, perceived changes in crrltwal values provoked uneasiness. Under these conditions, it is not surprishg that the "highly visible but stnicturally weak" (Cohen, 1972, 198) Anguillian adolescents become the target of the moral panic. The adolescents of the late 1990s, who have grown up in an economic and cultural system open to foreign currents and have appropriated aspects of global youth culture, are highly visible and vulnerable to the critique that they have abandoned traditional values. Aspects of adolescent sexuality that visibly transgress stated Christian noms, such as teenage pregnancy, provide a particularly potent symbol for social and economic changes that are perceived by many as threatening. Historical patterns of adolescent sexuality and reproduction, which are actuaiiy moving closer to sociaily stated noms, as demonstrated by the dropping number of births to teenage mothers, were made to signe the supposed moral decay of Anguilla. In this context, the moral panic reinforces the status quo and does not respond to the issue it raises. 1 have discussed the importance of C hristianity as an institution of Anguillian society and how the rapid spread of cable television has challenged the hegemony of the Christian worldview. 1 have also noted the long-standing contradictions between the Christian ideal and dominant family structure of the Caribbean, which begins to be approached fiom a secular angle with the amival of the United Family Planning Association in Anguilla in 1979. The sense of instability and risk created by these cultural viewpoints is fecund soi1 for the growth of a moral panic. Yet over and above their contribution to the panic, these discourses provide the contradictory cultural context in which Anguifian youth create and enact their sexual identities. As 1 came to perceive the moral panic, 1 also began to hypothesize that the clashing cultural discourses were a barrier to Anguillian adolescents achieving the best possible sexual and reproductive health and would have to be addressed in order to achieve better health outcornes. 62

CHAPTER THREE: THE EiYPOTHESIS The rapid change brought by the transformation of Anguilla fkom a subsistence to a consumer society, with luxury tourism as the main industry, provided fertile conditions for a mord panic about youth, youth sexuality and teenage pregnancy. Turning to the context of the moral panic, we fùid a profiision of competing cultural discourses. Ifa putative retm to traditional Anguiiiian values, founded on Christianity, is the solution put forward by the dominant voice fiom above, what are the other discourses circulating in the public sphere about adolescent sexuality?

1 hypothesized that clashing cultural discourses about adolescent sexuality and associated gaps between what was said about sexuality and cornmon sexual practices would make it extremely difficult for young people to gain the knowledge and skills to enable healthy decision making. What is a "healthy"decision about sexuality? It is a choice that promotes the physical and mental health of the individuai. 1 take the position individual well-being generally contributes to communal well-being. There are situations where choices that promote the sexual and reproductive health of individuals do not conform to communal noms but do promote communal well-being. An example is early rnamage and associated early childbearing. Early marriage and early childbearing is a nom in many societies but fiequently has negative consequences for the young wornen, their chiidren, and, consequently, the society as a whole. The nsk of dying du~g pregnancy or delivery is twenty to two-hundred percent greater for women fifteen to nineteen than it is for women twenty ro thirîy-four. Similarly, a comparative study of twenty countries showed risk of death by age five was twenty-eight percent higher for children of adolescent mothers than for children of women aged twenty to twenty-nine (WHO, 1998). Communities are heterogeneous and the risks and benefits that devolve f?om community norms are unequally distributed. Where community norms pose a threat to health and weil-being, spaces need to be opened for individuals to critically consider the effects of comunity norms on their well-being. While there is an interaction between community noms and individuai choices, decisions about how one uses one's body should rest with the individual and not the community. Men and women, even minors,28 have the nght and responsibility to take decisions about how to exercise their sexuality. These decisions must be made fiee fiom coercion and with a certain level of information if they are to wntribute meaningfùlly to the well-being of the person. A certain measure of self-awareness based on adequate knowledge of the biological and social aspects of fertility and sexuality is necessary to take healthy decisions about sexuality. Knowledge of and access to choices with regards to conception and contraception is necessary. Decisions about sexuaiity and reproduction made without knowledge of or access to modern reproductive health services should not be equated with unhealthy sexual decisions. To be healthy, people must have a way of understanding and controlling the sexual experience and its effects. The discourse must provide a coherent message with sdcient detail to be practically usefbl and must be flexible: it must offer the choice of saying yes and no to sexual activity and yes and no to conception. The narrative the information is embedded in could be traditional, modern, scientific, spintual or an arnalgamation of several knowledge ~ysterns.~~In fact, the narrative must Vary in order to respond to the specific lived reahty and ideds of the audience for which it is intended ifit is to be perceived as relevant, possible, and desireable. The return to traditional Christian values put forward in the AnguiIlian moral panic about teenage sexuality is inadequate because it does not respond to the lived realities of adolescents, is purely prohibitive rather than informative, and fails to respond to the multiplicity of traditional and

28~heterm "mature minor" is used most frequently in health policy. The medical service pruvider can offer senices when they have reasombly assçssed that the minor has the cornpetence, or rnaturïty, to understand the consequences of engaging or not engaging in a particular course of healih care and when the minor has refused parental involvement. The landmark case in English cornmon law for providing sexual and reproductive health information and services to minors is GiUick vs. West Norfolk Healih Area Authority (1985). The judge ruled the hdth service provider could offer contraceptive information and services to a minor under "exceptional cases", such as an emergency, parental negiect, inability to locate the parent. or where the minor has refiised parentai involvernent (UNFPA,199u 10-1 1). 291ndigeneous or traditionai howedge systems about se-dityand reproduction provide multiple practices for managing fertility, uicluding birth spacing, contraceptives and aborficients (Shiva and Hoiia Bhar, 1993; Coma, 1994; Fraser, 1995; Newman, 1985). Moreover, Bledsoe's work in rural Gambia demonstrates when women do incorporate modem contraceptives into their feitility management, they do so in ways which meet their own sexual and reproductive objectives. For e.uample, women uscd oral contraceptives to meet the new objective of resuming sexual relations more rapidly after birth while simultaneously achieving the more vaditional goal of bfeastfeeding and maintainhg culturaiiy detennined "decent" birth intenals. For their part, administrators of fdyplanning programs tend to label patterns of use as "unmet need," "discontinuation," "noncornpliance" or even "irrational" because the way the contraceptives are used do not correspond to the original Western formulations of these technologies (Bledsoe, 1994). modem discourses that could contribute to an Anguillian's sexual identity. The moral panic pretends to respond to an increasing number of teenage pregnancies, when there is no proof that more teenage pregnancies are occurring. In fact, births to teenage mothers show a steady and systematic decline ffom 1977 to 1997. The solution to "the teenage sexuality problem" proclaimed by the moral panic is also inadquate because it ignores the enduring structure of family and sexual culture, which prevails throughout the English-speaking Carïbbean and in which this "problem" is embedded. Deconstructing the logic of the moral panic offers understanding of one of the dominant logics operating in Anguilia with regards to adolescent sexuality: authority and punishment. The argument States that teenagers should not be having sex, that they should be obedient to God's law . If? they disobey authority, they shodd be punished. Removing punishment, for example, aliowing teenage mothers' to return to school, is perceived as encouragement of the unwanted behavior. It is important to recognize that while teenage pregnancy is pointed to as "the problem", what is rejected is not pregnancyper se but pregnancy as the evidence of sexual activity. The underlying object of the panic was made visible in two ways. First, transgressive sexuality as the

deeper core of the panic was highlighîed by insistence the data 1 provided about declining births to teenage mothers did not necessarily mean decli~inçpregnancies because young women could be going to St. Martin and having abortions. Reference to abortions signrfies the dominant interest was in the moral deviation of having sex before marriage, made visible by pregnancy, and not on the medical and socio-economic problems such as rnortality, morbidity, lower educational attainrnent, greater illness and unintentional injuries among children, and the cycle of poverty associated with early childbearing (Man Guttmacher Institute, 1994, 61-62; ECLAC, 1997, 1 14-

121 ; Nitz, 1999; WHO, 1998). Likewise, resistance to providing sexuality education and health seMces was fiequently expressed as fear these programs would encourage sexual activity among youth. In discussion with a school administrator about peer counselors offenng sexual and reproductive heaith information, 1 was asked: "isn'f@ing contraceptives or fafkingabout contraceptives iik sqying pre-marital sex is OK? ifis going along with the mrrent &y insfead of tïying fogo back" Field Notes, November 1 7, 1998). In this paradigm, educating young people to avoid the unwanted consequences of sexual activity, whether it be pregnancy or sexually transrnitted infeaions, is seen as encouraging unwanted behavior. The perceived Link between offenng sexual health education and seMces and encouraging sexual activity has two dimensions. In the Caribbean context, researchers have observed that the control of adolescent girls sexuality is typically a combination of authoritarian commands to avoid men and deniai of information about sexuality for fear knowledge will "put ideas in her head and make her 'force ripe' or 'big before her the' i-e. sexually precocious" (Senior, 1991,69).30In this case, the knowledge itseif is seen as dangerous. The second dimension is the perception that contraceptives aiIow young people to avoid the punishment for transgressive sexuality. The school administrator quoted above suggests denying information and services related to sexual and reproductive health despite his awareness that teenagers are having sex. In the same vein, not expelling teenage mothers fiom school is seen as removing a deterrent; becoming a mother as a teenager is not perceived as a sufficient punishrnent. The authoritarian command to avoid sexual activity in conjunction with denying sexual and reproductive health seMces and education, while simultaneously ignoring the sexual activity which is occurrïng, contributes to perpetuating precocious sexuality and the unwanted consequences. The authoritarian approach prevents the establishment of intemal resources or a self-directed priority setting and decision-making schema.

An upper manager îwice repeared thaf the problem is men in their mid-menties picking up schwl girls and coercing or rapi,tg them. His solution is to put up a no loitering zone around the school and make the food tmch move. J..] 1 was reminded of asking hvo schooi girls how to deol with sexuaily prerloo~men (iter they told me about a case of teerzage/chiildprostitutionat the schooo. One amered: '"builda realiy highfence. " The tipper manager's solution is essentially the same. (Field Notes, Jamary 6, f 999) The gate in the fence must inevitably open. When it does, a school girl or boy who has been "protected" fiom sexual activity through authoritarian means is unlikely to have the knowledge or skills to refiise sexual activity or plan and execute sexual intercourse while taking the steps to protect themselves fkom unwanted consequences. Senior correlates the two phenomena stating:

p~- 301t must be noteû that fear that sexual knowlcdge wilI lead to sesuai practice is not unique to the Caribbean. "The girl's upbringing is based more on the repressive measures of her parents than on the development of her own inner controls, a situation which fiequently results in early and unplanned

childbearing" (Senior, 1991, 40). The notion that sexuality is bad and that the consequences of sex are desewed punishments, and related feelings of guilt, rnitigate against healthy decision making. If teenage sex is considered by teenagers to be unacceptable, they are discouraged fiom thinking about the

practicalities of intercourse and choosing a method of contraception (Hatcher et al, 1994). Research fiom the United States correlates girls' expressions of guilt about their sexuality and sexual activity with lower use of contraceptives (Sosnowitz, 1995, 142). In contrast, an inner "discourse of desire" (Fine, 1988) that promotes feelings of desire and repulsion without confùsion or ambiguity is hypothesized to encourage clarity about which sexual activities are

wanted and which are not; in other words, the ability to Say no demands the ability to say yes as

well (Toiman, 1994; Toiman and Higgins, 1996). Individuai adults and Society as a whole exacerbate adolescents' ambiguous attitudes towards sexuai activity by refùsing to address the evidence of sexual activity (Hatcher et al, 1994). We see this refisai to confiont the actuality ofadolescent sexual activity in the comment: "isn't giving conîraceptives or taking about contraceptives Iike saying pre-maritu/ sex is OK? It is going ahgwith the mentdy instead of tryir~glo go back" Field Notes, November 17, 1998). In the Caribbean, the announcement of an unrnarried girl's pregnancy is fiequentiy ritualized. Mer ignorance on the part of the parents, the initial revelation is a traumatic event in which the young woman is punished with physical violence and frequently thrown out of her farnily home. Over the course of the pregnancy, the extended family with whom the young woman seeks shelter engineer a rapprochement and usually "the baby is literally bom into its grandmother's hands." (Saint-Victor, 1986, 86; Senior, 1991, 72-76 ). Foiiowing this pattern, health service providers in Anguilla reported that communication about sexuality from parents to children is ofien little more than wamings not to drink malt or taik to boys. Parents are aware their children are sexuaüy active but do not acknowledge the situation openly by talking about it. The announcement that a teenager is pregnant is greeted with dismay and anger, but by the tirne of the birth, the young woman and her child are integrated into the family unit (Field Notes, August 24 and September 29, 1998). If the Christian interdiction against sexual intercourse before marriage were the only discourse operatjng in Anguilla, it might be more successful. However, whiie dornuiant as the stated ideal, the Christian values are not the only ones expressed in Anguillian culture. In particular, the sema1 double standard, which tacitly accepts young men's sexual activity and forbids young women to be sexuaily active, while rnaintaining silence about sex, mitigates against the success of an authoritarian abstinence only message:

"There is no communication between childrer~andparents about semaliîy. 11''s he can go about but she better not get pregrîarlt. f.. .fie can be georgy porgy puddin ' and pie, kiss the girls md make them cry, bzit she has to be [Me red riding hd, and go home. [. ..] Ymcd reafiy talk about it [sex]. Ifym mked pub ficiy, ail the girls would be virgrgrm,ad aff the boys wddbe sexuah'y active. " flntewiew with AnguiIIkm man in hi.eariy thirlies, Field Notes October 28, 1998) The dominant authoritarian interpretation of Christian dogma about sexuality as expressed in the moral panic neither corresponds to the experience of many young Anguiiiians nor offers viable strategies for improving sexual and reproductive heaith. Rather than succeeding at the stated goal of preventing sema1 activity, the authoritarian approach serves to perpetuate a cycle of pregnancy, punishment and rnarginalization of the most socially and biologicaiiy wlnerable.

Following Harding's argument for strong objectivity, which situates ail knowledge claims in their historicai context and cnticaily examines a variety of standpoints while privileging the view fiom below as a starting point for generating knowledge, 1 sought to rnap the highly contradictory messages that contrîbuted to the discursive field of adolescent sexuality in Anguilla in the late 1990s (Harding, 1993). Strategies for assessing and improving the reproductive and sexual health of young Anguillians, which could go beyond the moral panic's construction of a new "crisis" in teenage pregnancy as a signifier for Anguilla's moral decay, demanded recognition if not reconciliation of the competing cultural discourses about adolescent sexuality. Recognizing that "stniggles over what will count as rational accounts of the world are struggies over how to see" (Haraway, 199 1, 194, 1 paraphrase four competing constructions of adolescent sexuality, which were circulating the Anguillian public sphere during the time 1 lived there: The Bible as represented in Anguihan churches; the sema1 culture described in soca; the di scourse on adolescent sexuality put forward by the United Nations Farnily Planning Association; and the influences of cable television, which are most obvious in Black Entertainment Television and the diet of hip hop that it serves. These four discourses have been selected because they illustrate the cultural tensions between incitement and prohibition of sexuality. This contradiction cannot be resolved by posing the discourses as old versus new or Anguillian versus foreign. While all of these discourses have been irnported to the island at one tirne or another, the dissonance between the narrative of the churches and the popular music of the Caribbean (calypso and later soca) stretches back many years. The more recent narratives about sexuabty put fonvard by the United Nations Family Planning Association and Black Entertainment Television play off against each other as weii as reuiforcing and refùsing the logics of the sexual discourses that came before them. With the exception of the moa recent narrative of the United Nations Farnily Planning Association, these discourses expound a patriarchal sexuality that positions women as subordinate objects of male desire andor sexuaily culpabable.These four synthesized narratives are offered in hopes the reader might understand elements of the highly polarized sexual culture of Anguilla. Imagine meeting these discourses as a researcher trying to elaborate strategies to improve adolescent senial and reproductive health, or as an Anguillian adolescent making sexual decisions.

The Exceptions to the Rule The discourses presented in this chapter as monolithic revealed cracks and fissures on closer examination. For exarnple, the band Square One is incIuded as representative of the soca discourse. The celebration of aggressive, abundant, and male-initiated sexuality, which dominates soca and is expressed clearly in the Square One Song "Kitty Kat", is not the only vision of sexuality put fonvard in the group's music. "Bumper Killer," a song on the same album Sung by the female vocalist, explicitly critiques and challenges the status quo:

When a girl pay she money, and she gone in the Party. She don't want nobody hassle she. But aU of the the boy your trying to wine and nibbing up on the young lady. When you see the bumper tuming, you better step back. When you see the barn barn rolhg you better beware, cause it will kill you. (Square One, "Bumper KiIler", 1998) "Bumper Kiiier" is an assertion of women's right to inhabit public places and "get down and wine" without continuous unwanted sexual attention fiom men. The lyrics are a radical departure fiom the standard message sent by soca and the standard practices in discos and Street dances. However, while Square One's "Kitty Kat" was in heavy rotation on the radio stations in the

Eastern Caribbean, 1was exposed to "Bumper Killer" only after spending the equivaient of twenty American dollars to purchase the compact disc. Likewise, the gender and semai relations I present as characterizhg hip hop are not the only messages put fonvard in the genre. Fernale rappers have appropriateci the musical form to reject women's positioning as the passive objects of male semial desire, asserted their own sema1 subjeahood, and critiqued gendered social relations (Rose, 199 1; Forman, 1994; Roberts, 1994;

Goodall, 1994; Shelton, 1997). An example of the critique offered by femaie hip hop artists, Lauryn Hill's "Doo Wop (That Thing)," was in heavy rotation on BIack Entertainment Television during the winter of 1998- 1999:

Now that was the sin that did Jezebel in. Who you gon' tell when the repercussions spin. Showing off your ass 'cause you're thinking it's a trend ...It's sUy when girls seU their sou1 because it's in. Look at where you bein hair waves Like Europeans, fake nails done by Koreans.... Guys you know you better watch out, some girls are only about that thing ...Money taking, heart breaking now you wonder why women hate men. The sneaky silent men, the punk domestic violence men. The quick to shoot the semen. Stop acting like boys and be men. ...Girls you know you better watch out. Some guys are only about that thing. (Lauryn Hill, "Doo Wop (That Thing)", 1998) Hill descnbes the same gendered semai relations as most of the hip hop on Black Entertainment Television, but she offers a reflexive critique rather than the standard glorification. Scholars who have argued for the empowe~gor emancipatory projects of female rappers admit these voices are set against a chorus of rappers, both male and female, who participate in the reification of patriarchal, homophobic and ultimately misogynist expressions of male sexuality (Rose, 199 1;

Forman, 1994; Roberts, 1994; Goodall, 1994; Cashmore, 1997, 165- 169; Shelton, 1997). The discourses presented below must be viewed as composite interpretations, and not literd representations, of the discourses circulating in the AnguiIlian public sphere. While there are variations and exceptions, 1 have chosen to present these composite pictures of the dominant discourses about sexuality and gender relations because redundancy and repetition are effective for shaping culture and blocking participants fiom imagining change (Eco cited in Christian Smith, 1994). The Rules AnguiNian Christianityl Scriptural Interpretatioa God despises and wams against sexual acts that are not blessed by the sacrament of marriage. Marrïage is the form of life that God has given to us, his children, that we may live happily according to his laws: "... for it is better to marry than to bum with passion" (1 Corinthians 7:9).Christians are counseled and exhorted to maintain their virginïty until marriage. Sexual union outside of marriage defiles a person in God's eyes; the only way to remah pure is to guard your virginity until you marry (1 Corinthians 7:28, Exodus 22: 16, Leviticus 21 :13). Christians are not denied the pleasures and satisfactions of a sexual He. In fact, true spirituality ailows us to resist pre-marital sex, which lads to damnation, and to increase the mystery, pleasure and ecstasy of marital sex. Wlthin marriage, men and women are invited to enjoy al1 the pleasures the union offers. In modem culture, sex has been made into a false idol, resulting in premarital sex, infidelity, and promiscuity. But within a Christian marriage, the man is to the woman as Christ is to the Church, and sexuality can be experienced as what it tnrly is, a beautifid gift from God: "May your fountain be blessed, and may you rejoice in the wife of your youth. A loving doe, a gracefii deer- rnay her breasts satisfi you always, may you ever be captivateci by her love" (Proverbs 5: 18-19). The truth and wisdom of God's word is shown in contemporary and popular studies that find the greatest level of sexual pleasure among mamed couples (Pastor Gumbs, Bible passages cited and annotated, Youth Consultation, February 18, 1999). Obeying the word of God and reaping the rewards is not optional. In today's pluralistic society, young people can be misled into believing al1 values are relative; those that are tnily spiritual understand that in everyday Me, as in science, there are absolutes. One of these absolute truths is that the rnost emotionally, physically, and spiritually satisfjing sex takes place within a union blessed by matrimony. True spirituality can give us the strength to resist the powerfiil urges, drives, and temptations we experience as young people (Pastor Gumbs, Youth Consultation,

February 18, 1999). To do othewise is to invite eternal damnation. Proverbs Chapter Five considers the temptations and consequences of sinful sexual behavior: "For the iips of an adultress drip honey, and her speech is smoother than oil; but in the end she is bitter as gall, sharp as a double-edged sword. Her feet go down to death; her steps lead straight to the grave" (Proverbs 5: 3-5). Al1 around us we see the consequences of disobeying God's laws. The destruction of the family, teenage pregnancy, and sexually transmitted disease are fictions Msited upon the human race because we have not foliowed the path God marked out for us in the Bible. The Lord's will is not hidden or dificult to know. Adultery, ïncest, bestiality, and homosexuality are abominations in the eyes of God. If we foiiow the precepts of God found in Leviticus, Chapter 18, Our families would live in harmony, and we would not be burdened with HIV/A[DS, syphilis, gonorrhea, and

Hepatitis B (Field Notes, September 15, 1998). The story of Sodom and Gommorrah warns God will not brook the insubordination of his people: "Then the Lord rained upon Sodom and upon Gommorrah brirnstone and fire fiom the Lord out of heaven" (Genesis, 19:24). In the past, God worked in dserent ways than he does in modern society, but he remains present and observant:

"For a man's ways are in full view of the Lord, and he examines ail his paths" (Proverbs 5:21). We must ask ourselves why we know so little about the transmission of AIDS. And why, despite the advances of modem science, has no cure been found for the ADSvirus? AIDS is a warning that we must turn away fiom the sinful path and follow the Lord's way to spiritual and physical health

(Field Notes, September 5, 1998). There are some among us who would claim that despite the failure of modem medicine to provide a cure for AIDS, it is possible to prevent pregnancy and sexually transmitted disease. But

1 put it to you that to provide such medical services to young people is to aid them and abet them in their sin. ifyour child was breaking the eighth commandment by stealing fiom a second story window, would you b~ghim a ladder? (Field Notes, February 11, 1999) Anguillians always have been and continue to be a God-fearing people. To protect the tme Anguilla, we must educate Our young people and instili in them the moral attitudes that will lead thern to foilow God's dl. We invite you to have a good tirne. Babylon doesn't Sie us, but they should cool down

'cause we're just having fiin.32 The whole region and people fiom around the world are here, and we're going to have a Party. Let's wine and grind until the Sun coma up. Show me, show me, show me how sexy you are! ! Sex is a natural appetite. Everybody has it, and everybody wants it.

Don't be shy- soca makes the mouth water! Everything's cool, it's caniivai time. Oooh, look at that barn-barn. Ladies, show us what you've sot: "You dont have to be Miss Universe; To show that you're sexy fike a curse; Be proud of your body, thin or fat; Show off that your sexier than that" (KrossQah, "Sexy Finger," 1998).Your sexiness shesfiom the inside out, so lets get together and wine. Some like a big bumper, and some iike a small tight bumper but everybody gets aroused surrounded by such sweet shapes. Those women are hot, man! And they must be satisfied.

Can you handle your business? Ifyou can, women are waiting for you. "You tink [sic] you can handle me? ...WeU, corne and bring that needle. 1 want a man who can ride me rigid, 1 want you to ride. If you think you're sexy and you know your ready, if you think you're sexy," corne show me what you got (Square One, "DJ Ride," 1998). Have you got the endurance and rhythm "to make she surrender" (The Mussingtons, "Backshot," 1998)? Before you begin, let us give you some tips. You've got to "pump up, show no mercy; size of it doesn't matter, once you know how to work your harnmer." (Krossfjmh, "Hammertime," 1998). Get pumped up on energy with a traditional or modem aphrodisiac (Vito Band, "Viagra, " 1998).Then, if you think you're ready, "It's time to ride. Ladies assume the position of the horse. Fellas, you know what to do. You are the riders. Saddle up. Hold on tight. Serious business. Your moving so sweet and so nice, you might get yourself in trouble and [ose control (KrossQah, "Pony Ride," 1WS)."

lThe soca rlectcd here is the music 1 heard attending the performances of local bands and listening to local radio stations. 32~onfkontationwith and rejection of authority and the boasting which is central to both caIypso and its popuiar dance descendant, soca, can bc traced to musical anteccdents of these styles. Calypso evolved fkom calinda and "sans humanite." which are boasîhg and challenging songs dating from the colonial era, which traditionally accompanied marching and stick fighting. The tradition of male boasting remthe same, but the attacks on colonial auîhority are now phrased as defiance of Babylon. The machisrno and sexual boasting which characterize thesc older fonns can be seen in calypso and soca as well as rap and hip hop (Manuel 1995, 183-197 and 237- 240; Hebdige, 1987,39). Are you up for the challenge? In the party or the bedroom, a man who can't match his woman move for move isn't a man. So before you walk up on her, make sure you can handle her. If you leave her wanting more, she'U be hornin' you (Better Band, "Mo Hose," 1998).33 If your woman wanders, you can win her back by showing her what you got: "somebody kitty cat get away and dey behavin' bad; somebody kitty cat get away and it's divin' dem mad. Hold it down when you get the cat, you must hold it down. Attack it fiom the front, they tell me. Attack it fiom de back, hmmhmrn" (Square One, "Kitty Kat, " 1998). Sex sweetness is an insatiable craving. You're hungry for it, and you must be satisfied. Sex is what it means to be a woman and what it means to be a man. Take pleasure (the more the better), give pleasure (the more the better), and prove yourseif (the more often the better). United Nations Family Planning Association The sexual behavior of adolescents should be a serious concern for international organizations inside and outside of the UN system, national and regional governrnents, local communities and youth themselves. Global and individual quality of life today and in the fùture is determined to a large extent by the decisions young people make about their sexuality and fenility. The world currently has the largest population of adolescents in history. In 1995, half of the world's population was under twenty-five, including more than one billion adolescents between the ages of ten and nineteen . The sexual behaviors of these adolescents is putting themselves, their societies, and indeed the global comunity at risk for sexually transmitted diseases including HIV/AIDS and early and unwanted pregnancy with ail its sequelae (International Planned Parenthood Federation, 1995, 2). The costs of unprotected adolescent sexual activity are costs individuals and communities should not have to bear and indeed cannot pay. The cost can be avoided by responding to the reproductive health needs of adolescents. Central to ensuring the reproductive health needs of adolescents are met is increasing their legitimacy by building a consensus that sexual and --- - 33 "hegot a fire in my kitchen. My husband's not at home. Won't you corne on ovcr to help me put it out. He hose too short- Just too short- The hose can't reach. Just can't reach. Gimme more hose, can't reach the fire. Gimme more hose 1 can't reach the fie. Gimme more hose. don't let go the wvatcr." Betîer Band, "MoWose," 1998. "Homin"' refers to "putting the horns on" or "cuckholding". reproductive right s are indienable, integrai and indivisible components of universal human rights. Sexual rights include the human rights of al1 people, regardless of age or gender, to have control over and decide fieely and responsibly on matters related to their sexuality, including sexual and reproductive health, ûee! of coercion, discrimination and violence (UNFPA, 1998d, 19; UNFPq 1998e, 4-5). Within the prograrns to improve adolescent sexual and reproductive heaith, young people are encouraged to make decisions for themselves about matters which have important social and moral aspects. In many societies these decisions have been taken by adults or made at the comrnunity level (UNFPA, 1 998d, 10- 1 1). Sexual rights is a revolutionary concept in that the rights adhere to and are exercised by the individual. If education, information and services are not provided, adolescence is often characterized by sexual and reproductive risk taking. Contraceptive use is low due to incorrect information or Limited access to contraception because of location, cost or social and cultural barriers. The costs are huge. Unsafe abortions, premature childbeming and sexually transmitted infections have impressive impacts on individuals and societies. Motherhood at an early age iimits opportunities for education, particularly arnong the less privileged and thus reproduces the cycle of poverty. The loss of large segments of the productive population to AIDS is now making itself felt in the national productive and subsistence economies of some countries. Unde sex and development are not compatible. The world of today's adolescents is very different fiom the world of their parents and grandparents. The traditional systems of education and control over adolescent sexuality have eroded as the influence of the family has eroded relative to other cultural influences. In many cases familial education and socializattion with regards to sexuality has not been replaced with sound alternatives (UNFP& 1998e, 6; UNFPA, 19984, 10- 12). Reproductive health professionals, in collaboration with the other stakeholders, must make sure effective and appropnate education and services are provided to help adolescents attain the maturity necessary to make responsible decisions (UNFPA, 1998e, 4). Other stakeholders, such as national governments, religious groups, parents, and adolescents themselves, may be resistant to sexual education and reproductive health services because they are misinformeci about the goals and effects of providing sexuality education and health services to adolescents. For example, many people are &aid that sexuality education wiil lead to earlier and more fiequent sexual activity arnong adolescents. In fact, comprehensive studies of sexuality education programs demonstrate sexuality education has no effect on or delays the onset of sexual activity and is more effective when offered before young people become sexualiy active. Education that promotes sexual delay and protected sex is more effective than abstinence only programs. Young women who receive comprehensive sexuality education are more likely to use contraceptives at first intercourse. Al1 of the stakeholders have the comrnon goal of a raising healthy children and adolescents and having a healthy society. Once the stakeholders understand that sexuality education and health services are an integrai step in the

Iadder to achieving a healthy and prosperous society, their resistance will subside, and in many cases, they wiU become enthusiastic advocates for adolescent sexual and reproductive health and rights. For this reason, signifïcant energy must be devoted to educating the adults who duence and provide services to adolescents (UNFPA, 19986, 10-1 1). Yet, we must not, as we have in the past, overlook the very important contribution adolescents can make towards improving their own sexual and reproductive health. Adolescents should be the subjects, not objects, of adolescent sexual and reproductive hedth programs (UNTA, 1998e, 11) Youth participation can be stimulated through adolescents participating as delegates in regional, national and international debates, essay writing contests symposia focused on reproductive and sexual health and other fora. The young people selected to participate in such programs should have a demonstrated interest in the topic, be able to articulate themselves effectively in a public forum, and be leaders in their community (UNFPq 1998%7). Adolescents are the most effective advocates for and educators of other adolescents. Their energies must be mo bilized.

Adolescent sexual and reproductive health rights are human rights. They must be respected by providing information, education, and reproductive health care services. Doing so is a foundation for individual happiness and national development. Not doing so is a recipe for chaos, death and destruction Hip Hop The best things in Life cost cash. If your roll is fat and the dollars are swiriing down, the clothes, cars, drugs, diamonds and sex are yours for the asking (visud: R Keiiy featKeith Murray, "Home Alone," 1998).35 Without money you're nothin', wiîh it you can have it all.

Dollars wili meet your physicd, social and emotional needs.

1 believe in money, power and respect. First you get the money. Then you get the motherfÙckin' power. And &er you get the fuckin' power, you get the fùckin' niggaz to respect you. It's the key to life ...You'll be eatin right ...You can sleep at night...Youtii see the iight [with] Money, power, respect. (Liî' Kim on The Lox feat/ Lii' Kim &Dm"Money, Power, Respect," 1997)

3%e songs and videos selected as represenîative of the dominant messages about seyuality and male female relationships çonveyed by hip hop were in heavy rotation on Black Entertainment Television's "BET Hit List" (a t-iewcr request programme) in Janwry? Februaxy and March 1999. The format is two rap or hip hop videos followed by two R & B ballads, followed by advertising. The songs selected are Born all three genres. Black Entertainment Telaision was chosen as the source for hip hop because it scored highest in preference for television channels among Anguiilïan youth (Kendall, 199th). Black Entertainment Television, which is targetted at and comsumed rnostiy by viewers in the fourteen-toeighteen year-old age range is a primary source of e.vposure to global youth cuiture for Anguillian young people. Black Entertainment Television began in 1981 and is now available in 56 miUion households in thirteen counuies. The cable station is an excelient example of the multi- product, cross-marketed entertainment ventures which have becorne the mode1 in the 1990s. BET Holdings owns . and operates: Black Entertainment Television, BET on Jazz; BET Moviesl Starz!3;BET International; BET Design Studio; BET Action Pay Per View; Emerge; Hart and Sou1 and BET Weekend Magazines; Arabesque Books; BET Financial Services; BET Soundstage Restaurant: BET Soundstage Club; the BET on Jazz restaurant (w~vw.BET.wm).To mark BIack History Month in 1999, BET launched Urban E-upress, "the search engine for the hanconsumer"(Business Wire, 1999a; McConvilIe, 1999, 14 ).

35 The desires of îhe Afiican American consumer and their desircability as a market bas been an explicit discorn among the black executives who have shaped and promoted the hip hop lifestyle. Cross-marketing and selling to the black consumer are the selfconscious raisond'etrc of BET. As Bob Johnson, BET's founder, said in 1982: "Our network is not a radical departurc for N...wve have not reinvented the wheel, only painted it black" (cited in Tait and Barber, 1996, 193). The programming enviromnent of BET is self-consciously oriented to provide a setting conducive to the sale of Fubu, Nikc and filfiger. Stephcn Hill, fomerly of MTV, took his move to BET as an opportunity to comment: "BET understands the value of music and the infiuence it has on consumers; I'm very pleased to be part of BETs bright firture (Business Wire, 1999b). Russell Simmoas, co-founder of Def Jam, and one of the first young, black middle-class American's who became rich in the early nineties by prornoting American ghetto culture in the form of rap had this to say about black consumers "They're the only people who buy up other than the rich. They buy into the Amcrican ciream. They buy success. They buy Hilnger. They'ii pay whatever for a shirt. They'il pay for the name, the cut, the logo. the marketing (Lorey, 1995 cited in Cashmore, 1997, 160). Within this narrative, Afncan Americans arc constnicted as "super-consumers" and payments to promoters and cable television stations are posited as a wvay for the corporation to "value" black Amcrica. Louis Carr, BETs Vice President of Media Sales cornplains Reebok: "just doesn't see the value of the Afncan-American audiences. They told us 'We aren't paying that for you guys.' Which is amazing to me when you look at what they're paying for ESPN. Now, 1 understand the programming environment and ail thai, but when you look at who buys three-plus, four-plus pairs of shoes a year, our (audicnce) indices and numbers arc much bctter than ESPN's cver will be" (cited in Ross, 1999: SI). You are in the marketplace and you got to have a currency to trade. If you've got money, you've got no problerns. Where it breaks domdiEerent for niggaz and the hoes is a man needs cash, but a woman can trade ass. Men "get power, get money and then get fucked" (DJ Quik, Feat and 2nd II None, "Hand n Hand," 1998). A man without money is a man without buying power in the sexual marketplace. "1 dont want no scrub. A scrub is a guy who that can't get no love from me. [...] Ifyou dont have a car and you're walking ...If you live at home with your momma. ..Wanna get me with no money.. .No scrub, no" (TLC,"No Scrubs," 1999). The matenal things in Me are a man's responsibility to provide. A man who cannot support a woman, buy her gifts and pay her bills is not a man: "You're slowly making me pay for things your money should be handiing... SiUy me, why haven't 1 found another?... 1 need someone to help me out. Lnstead of a scrub like you who don't know what a man's about (Destiny's Chiid, "Bills. Bilis, Bills," 1999). If a man can't meet his part of the bargain, then a woman with self-respect had bener be walkllig: "Can you pay my bills? Can you pay my telephone bills? Do you pay my automo' biils? If you did, then maybe we could chill. 1 don't think you do. So, you and me are through" @estinyts Child, "Bilis, Bas, Bills," 1999). A real man is good at the bank and in bed, satisfjmg his woman or women materially and sexually. A woman sleeping after "fieakin fiom dusk to dawn" is a nice sight fiom cleavage to navel ring and proof of "...the way it flows when it gets real good, back to back flexin' my manhood.. . 1 broke you off al1 night and I'm not tired. Bring your body here and take me higher"

(Keith Sweat, lyrics and visuals, "I'm Not Ready," 1998). No man can resist, so most of us say women have to dole it out, keep it sealed or just say no (Goodall, 1994, 88-89). Even when a woman meets a man who loves her and wants to wait, she'll have to take control because a man is too weak:

Come on girl you know 1 need it. ..And 1 know true love's insisting we don't have to rush at all. 1 don't make promises cuz 1 know my hart gets weak. When 1 get around you girl, it makes them hard to keep. You bring out the best. You make me the man God knows I'm proud to be. @ni Hill, "These are the Times," 1998) If she gives it up too easy, she's got to be a siut or a fool: "Ex-girbend, how you ben? 1 see you aiii tryin' to fûck other women men. Remember when 1 first met you in my cousin's house, a week later we was fûckin' on you momrna couch." (Method Man Fait/ D'Angelo, "Break Ups 2 Make

Ups," 1998). A woman iike that just can't be trusted, while fkom men it's got to be expected: "If you cheated on him, how I know you aui't gon do it to me? .. . what you're doin is wicked. Now

I'm having second thoughts about you and me" (Ginuwine, "What's So Different," 1998). Men wiil chat and women will too, but a woman is the one to brame. Words and Context Post-structuralisrn argues discursive practices do not simply describe but constitute their objects. While power is unevenly distributed between discourses, for exampie the scriptural description of adolescent sexuality is given more weight by "respectable" people in the public sphere than the sexual ethic put fomdin soca, al1 of the subjectivities are "always caught up in a system of references to other books, other texts, other sentences: it is a node within a network" (Foucault, cited in Malson, 1998, 27). 1 hypothesized that the polarization and contradictions of the discourses about adolescent sexuality would present barriers to young people attaining optimal sexual and reproductive health as well as to changing the public health education system to better recognize and meet these needs. The ways in which these discourses interact and the challenge and opportunities the contradictions present were illustrated in the foliowing views of adolescent sexuaiity Erom below and above. A View from Below: Youth Consdtation on Adolescent Sexual and Reproductive Health The process for the Anguillian Youth Consultation on Adolescent Sexual and Reproductive Health was a series of speakers on aspects of youth and sexuality in the moming (physical, social and emotional dimensions of puberty, media, religion, presentation of survey data), and working groups in the afternoon. In the working groups, youth chose priority areas for action and developed short dramas to Uustrate why these issues were important. In a skit about the importance of sexuaiity education in the high school, participants enacted the following story. A young woman asks her mother for permission to go to a "Christian" party with a girlfnend, while she really plans to go to a Iocal disco. Her rnother gmdgingly agrees and sends her mini- skirted and tight t-shirted daughter off with a waniing "not to let any boys touch your breasts."

The disco scene was fûii of the sexual incitation of soca and gyrating bodies. Caught up in the music, abandoned by her fnend and full of curiosity, Our protagonist accepts an invitation to the parking lot of the Red Dragon Disco. In the third scene, the young wornan confides to her girlfriend that she thinks she may be pregnant, and the two of them inforrn the mother together. In response to her mother's anger, the pregnant young woman insias: "1didn't let any boys touch my breasts, but he touched everywhere elm." Her protest is to no avail; her mother bats her and throws her out of the house (National Youth Consultation on Adolescent Reproductive and Sexual Health, Anguilla, February 18 1999). This scene is an illustration of the authoritarian, scripturally based interdiction of semal activity by adolescents within the secular sexual culture of Anguilla. It also speaks to the dynamic relationship between sexual transgression and punishment, which mns through the Anguifian constniction of sexuality. The protagonist Lied to her mother, and hidmg behind the facade of a

Christian party, ventured into the sexually charged atmosphere of the disco. Her transgression is punished with pregnancy and expulsion fiom the family home. In this respect, the skit replicates the dominant Christian discourse about adolescent sexuality. What varies in this view Erom below is that despite punishing the young woman, the skit exonerates her because she was ignorant. Although she lied to her mother about where she was going, she obeyed by not allowing any boys to touch her breasts. The consequences of her obedience points to the outcornes of denying young people the knowledge and skills which could support infonned sexual decision making. A View From Above: Stakeholder Meeting Conflict between the strongly religious bent of Anguillians and the secular description of the world put fonvard in professional training institutions and international organs such as the World Health Organization and the United Nations Farnily Planning Association are a barrier to planning and delivering sexual health seMces that respond to Anguillian sexual culture. The multiple belief spheres that my supe~sorsand CO-workersoperated in were Erequently evident. Incidents during the presentation of the survey findings to elementary school teachers provide an encapsulation of the conflict: A teacher stïuîed quoting scripfure atrd suyi~~grhat WHO and the UV system me ffhurnanistic"systems thr teach: "man made God and not the other way around " He paraphrased the he0 Presidenr as suyit~gthar to estabiish a worid government you would hmre to do away with country, regionui, reliesand fmnify values. He presents this as an attack onfmily values d proof of WHO'S evil intent. [..] Ben John [àn upper manager] statu& up ami tries to ~fraddlethe divide pehveen religious belief andprofessiottal credibility]. He says: " I also believe in abstinence. I am a church elder. But we have ail kindr of people in Anguilla (Muslims, atheists), and as a professionai, I have to reach ail of them. " John conciuaks by Wingscripîwe about Jems loving sinners and saved equalb. (Field Notes, February 12, 1999)

In this setting, the antagonism between saçred and secular belief systerns makes it dificult to address the disjuncture between what "should be," i-e., adherence to scnpture, and "what is," Le., comrnon sexual practice in Anguilla. in order to simultaneously retain mord credibility while responding to research he believes is valid, John makes reference to his position as a church elder, descnbes Anguilla as a pluralistic Society and grounds his position in scnpture. Even if ail of the respondents to the 1992 census who are classified as belonging to "other" religions were non- Christians, (which is unlikely given the profusion of evangelisal Christian sects on the island), this group and the people who did not designate a religious mation would represent only seventeen- percent of the Anguiiiian population (Statistical Unit, 1992). Thus, assigning the demand for sexud health services among adolescents to religious pluralisrn is inaccurate. This exchange demonstrates both the extreme polarization between the dominant Anguillian interpretation of the scnpture and the position put fonvard by institutions such as the World Health Organkation and types of arguments and moral credentials which may be employed to argue for provision of services and education in this atmosphere. Conclusion The highly contradictory discourses on adolescent sexuality, which circulated in the AnguiIlian public sphere du~gthe tirne 1 undertook my research, were a barrier to improving the sexual and reproductive health of young people. However, the disjuncture between ideals for sexuality and comrnon sema1 practices provided an entty point into a discussion that could create practice that would better serve adolescents. Recognizing the issue of teenage pregnancy was embedded in a moral panic, and situating the contradictory discourses, permitted me to label the logic of transgression and punishment that operates in Anguilla. Reading the survey data, and

gaining more respect for the complexïties of the Anguillian sexual culture, led me to focus on the divergence between dominant discourse and common practices, or as 1 phrased it, "sexual ideals" and "sexual realities." Through the recommendations, public consultations, and media conferences that comprised the dissemination portion of the project, 1 attempted to refute the assumptions of the moral panic and invited Anguillian stakeholders to participate in these discussions. In retrospect, the notion 1 could play a major role in redefining the terms of the semai culture

smacks of naive arrogance. However, the consultations were aiso born fiom the humbling recognition that the partial nature of rny own understanding limited my ability to put forward solutions. For example, whether they belonged to the non-practicing minority or were heaviiy involved in their church, every hguillian 1 met could quote scripture. As 1 am not a Christian and have a limited knowledge ofthe Bible, 1 knew 1 could not speak the biblical language fluently. 1 read the Bible, attended church seMces and tried to absorb the logics of the scriptural discourse by practicing "strong objectivity." Despite my efforts, 1 recognized 1 did not have the depth of understanding to flexibly and creatively integrate the Christian nom and the Anguillian reaiity . Thus, I tned to refiame the adolescent sexuality "problem" in public consultations where Anguillian stakeholders could discuss possible soIutions. CHAPTER FOUR: TEtE STRATEGY The polarized discourses around adolescent sexuality circulating in the public sphere in Anguilla and the volatility of the subject matter as a consequence of the moral panic played an important role in stnicturing the sharing of information gathered by the National Adolescent Reproductive Health Survey. Recogninng the thrust of the moral panic and the multipiicity of discourses circulating about adolescents and sex, 1 abandoned my early assumption that the problems associated with adolescent sexual and reproductive health could be solved by "b~ging attention" to the issue. In fact, as 1 have described, adolescent sexuality was receiving a great deal of attention as a social problem which was taken to symbolize the moral decay of Anguiila. Under these conditions, it seemed irnperative to present the survey findings in a way that would not fbel the mord panic or fùrther polarize viewpoints. The potentiai for backlash which would inhibit existing access to sexual adreproductive health programs or create new obstacles which could act as long-tem deterrents for the creation of new programs was at the forefiont of my mind:

I am worried about tetling the truth as I see it: the kids partr*cipate in the dominant betief sysiem, but that belief sysîem is rtot going io protect them fiont early seddebut and u~tsafesex. I feet like 1am holding the rnaierialsfor a bomb irt my ha& and l am scared of the falto~it.Partly serfish, ifpeople do& fike what I say, 1 witl be shuttned or attacked. Partty athwistic, if it is ZOO rnzich* or too heavy, or ZOO alietmting nothfitg will happe,?. The follow-up will be hopped fike a hot pota~o." Field Notes Decem ber 4 1998' The strategy 1 adopted was to give presentations to various groups of stakeholders. The presentations were fYamed as opportunities for the stakehoiders to learn about the status of adolescent sexual and reproductive health, ask questions, and collectively consider what follow-up or next steps shoufd be taken based on the research findings. 1 made presentations to the senior managers of social services, primary health care and secondary health care; middle managers of education, primary heaith care, secondary health care, comrnunity development and welfare; the elementary and secondary school teachers; a press conference of prht and radio joumalists from Anguilla and St. Martin; and thirty youth at the Youth Consultation on Adolescent Sexual and Reproductive Health. An executive surnrnary, which highlighted the main points of the argument, was circulated to al1 of the elected members of govement, the Executive Council. Each presentation was followed by a question and answer session, discussion of how to proceed, and an invitation to participate in or give more feedback to the rnulti-sectord cornmittee which was to respond to the report.

The gaps between the sexual ide& of Anguillian adolescents and thek sexual behavior emerged very strongly f?om the survey data. 1 used this divergence as the linchpin to argue against the moral pariic's construction of youth as morally compt. The attitudes expressed highlighted Anguillian young people's stated desire to conform to Christian values. 1 did not attribute the fact that considerable numbers of young people were not conforrning to these norms to the failed moraiity of youth. Instead, the contrasts between what young people hold up as ideal and their perception of what Anguillian's do sexually, as well as the prevalence of semai coercion, was described as a social context that makes it dficult for young people to realize their ideals. 1 focused on the public health system and public education system as potentiai supports for young people bringing their sexual ideais and realities closer together. Ambivalence deriving from slippage between stated norms and practices, Iow knowledge levels about sexuality and reproduction, inconvenient se~cedelivery, and fear of negative judgment and breeches of confidentiality were specific areas targeted for improvement. In this way, 1 attempted to move the debate on adolescent sexuality away from categorizing young people as moral deviants to describing young people as moraiiy virtuous but needinç assistance in order to live those moral values. The following chapter is a synthesis of the report 1 wrote for the Ministry of Social Services and the argument I made in the public consultations. The Presentatioo The IdeaIs Anguillians cm be very proud of the values held by young people. Of the youth surveyed, ninety-five percent indicated they intended to finish high school and eight-seven percent aspired to tertiary education. While it is unlikely al1 of the young people who wish to seek post-secondary training wiil be able to do so, the desire expressed is an indicator of the importance young Anguillians place on education. AnguiIlian youth are taking an active role in personal and community development. Seventy percent of the young people surveyed reported involvernent in extra-cumcular activities. Churches play an important role in providing these extra-curricular activities to young people and guicihg them in their personal development. Eighty-nine percent of the students reported attending church every week and forty-two percent spend between three and fifteen hours a week in church-based activities, suggesting religion plays a crucial role in their lives. Given the emphasis on education, personal development and religion in their time allocation, it is not surprising Anguilla's youth agree that delaying the onset of sexual activity is beneficîal. Eighty-eight percent of the young people indicated that people should wait until they were married or had finished high school before becoming sexually a~tive.3~The pro-abstinence message, which has been promoted by PNnary Health Care, the education system and the churches, accords with the stated beliefs of the students. Eighty percent of the respondents felt abstinence was the best choice a teenager could make, and seventy-three percent of the respondents indicated they did not feel that sex was an important component of a teenage relationship. While the pro-abstinence message is dominant, there were gender ditferences, with boys tending not to agree as strongly with the importance of waiting until marriage to become sexually active or of remaining abstinent.37 While sixty-percent of the total respondents felt it was best to wait until marriage to begin sexual intercourse, only forty-six percent of boys held this ideal while sixty-eight percent of girls believed abstaining fiom sema1 intercourse until marrïage was the best choice. Likewise, thirty percent of the male respondents disagreed with the statement that abstinence was the best option for youth, while only eleven percent of the female respondents disagreed with this statement. These dserences indicate the importance of placing special emphasis on targeted sexual health promotion and education for young men, especially as maies are fiequeritly the primary sexual decision makers.

36~n%me cases, the respondents indicated that ihe ideal iime to begin semial actMty was seventeen to eighteen years of age and &er getting married. in these instances, seventeen to eighteen years of age was coded as the response. 37~heparticipants in Anguilla wcre a random sample of in school ywth fiom the 2,3,4 and 5th forms. The majority of the respondents were between twelve and sivteen years of age. 58% were in the 12-14 age range and 38% in the 15-16 age range. A mere 4% were 17 or 18 years of age. Female respondents outnumbered male respondents almost 2: 1; 64% of the respondents were fernale and 36% male. In order to expose bias creuted by the predominance offernales in the sample. a gender disaggtegated unaiysis was conducted; where male and female responses difler significanfly. it is noted. The attitudes about sexuaiity expressed by the majority of youth agree with the Christian

values which characterize Anguilla. Young people do not need to be convinceù that abstinence is a good thing. The survey data clearly reveals sexual abstinence until completing secondary schooi, if not until marriage, is a comrnon goal of young people. This goal is shared by professionals who work with youth as weli as the larger society. Unfortunately, the survey data aIso indicate hguillian youth are not achieving their ideals with regards to their sexual and reproductive health. The Realities Despite public concem about increasing numbers of pregnancies among teenagers, the birth records of the Princess Alexandra Hospital record a steady and sustained drop in the number of births to teenage mothers since 1979. Yet, whiie there is no indication that the fiequency of teenage pregnancies is rising in Anguilla, the proportion of sexuaiiy active adolescents and the sexual practices they report means adolescent sexual and reproductive hdth needs to be considered a priority in Anguilla. The picture of adolescent sexual activity and risk factors for prepancy and sexuaiiy transrnitted infections in Anguilla are comparable to the rest of the English-speaking Caribbean. The 1998 Pan American Heaith Organizaîion status report on Adolescent Health, which surveyed Antigua, Dominica, Jamaica and Grenada, found that forty- one percent of the adolescents surveyed reported having had sexual intercourse (Blum et ai, 1998, 14).38Forty-one percent of the Anguillian adolescents surveyed also reported having engaged in sexual intercourse. The gender difFerence is significant, with one third of girls and one haif of boys reporting they have had intercourse. Analysis of the responses of the teenagers who reported being sexually active provides evidence of well established risk factors for sexuaily transmitted infections, such as eady age at first intercourse, multiple partners, unprotected sex and semal

38The similarities in the data fkom the diaerent counuies, despite varied sampüng techniques, is a tesiimony to the reliability of the findings (Anelce Venema, MD, presentation at the UNFPA Youlh Summit, October 6, 1998).The ratio of fernale to male respondents in the PAHO survey was constant across countries and similar to Anguilla Si'cty percent of PAHO's respondents were female and fourîy percent male. in Anguilla, sixty-four percent were female and thirty-six percent male. The gender diEerentials for reporting having had sex were also similiar. In PAHO's survey, twenty-five percent of girls and sixty percent of boys reported having had sex. In the Anguilla mey,thirty-three perœnt of girls and nfty percent of boys reponed having had sex Consequentiy, it is reasonable to postdate that if the genders had knbalan- a number of respondents reporting having had sex would be stightly higher (in the range of fourty-two percent for Anguilla, and fourty-rhree percent for the PAHO sample). coercion. In Anguilla, nineteen percent of the respondents who have had sex report first intercourse at or below ten years of age; twenty-four percent report becoming sexuaily active between eteven and twelve years of age; thirty-seven percent first had sex at thirteen or fourteen; and nineteen percent became sexually active at fifieen or more years of age. The proportion of Anguillian youth who are sexually active at ten years of age or younger is considerably lower than the proportion reported by PAHO for the English-speaking Caribbean- For Grenada, Jamaica, Antigua and Barbados, forty-two percent of the respondents who reported having had intercourse

indicated their age at first intercourse as ten years of age or younger (Blum et ai, 1998, 14). The low age at first intercourse reported by a considerable number of Anguillian young people indicates a need to extend sexuai health education into the primary school system, however, it should be recognized that Anguilla is doing considerabiy better in this respect than many of its neighbor islands. One of the primary reasons young age at first intercourse is considered to have negative

outcornes for sexual health is because it tends to increase the number of sexual partners over the life span. In the case of Anguilla, thirty-nine percent of the group of adolescents who reported having had sex had had three or more sexual partners since initiating sexuai intercourse. Multiple partners need not present a health threat if individuals are consistently practicîng safer sex. However, the National Adolescent Reproductive Heaith Survey indicated that about half of Anguilla's sexually active young people are at risk of pregnancy, sexualiy transmitted disease and HIV/AIDS because of unsafe sex practices. Sixty-one percent report using some form of contraceptive at last intercourse, but only forty-eight percent of the sexually active adolescents stated they use condoms consistently. Why, when only three percent of the students surveyed considered it ideal for people of their age group or marital status to be sexually active, have forty-one percent of the students had sexual intercourse? The sexual activity described does not take place in a vacuum. The gap between the ideals adolescents hold and their sexual practices and their perceptions of the sexuai behavior of other Anguillians is an expression of confusion created by contradictions in the semai culture. The siippage between the normative Christian discourse and perceptions of nomal sexual practice is a common feature of research on sexuality in Anguiila. In the Adolescent Reproductive Health Survey, sixty percent of the respondents indicated it was best to wait until marrïage to have sexual intercourse; eighty-five percent of the respondents felt that most Anguillians did not conform to this cultural ideal. In a knowledge, attitudes and practices survey conducted with the general population in 199 1, high value was placed on monogamy and sexual fidelity with over ninety-four percent of the population advocating monogarnous relationships. However, eighty- four percent of these same respondents believed that most men they knew had sex with more than one partner simultaneously (CAREC, 1991, 56). The variation between what is held up as the ideaf and the actual or perceived behavior of role models creates an ambiguous situation in which it cmbe dficult for young people to know whether to "do as they say, or do as they do". The contradictions between normative discourse and nomal practice is only one part of the puzzle. The reported incidence of sexual coercion and the large age differentials between adolescents and their semal partners provide another part of the socid context for understanding the sexuai behavior of Anguillian adolescents. Of the respondents who reported having had sexual intercourse, almost halfof them report coercion at first intercourse; sixteen percent indicate they were forced and thirty-the percent report being "sort of' pressured into the sex act. Sixty percent of young women and thtrty-five percent of young men reported being coerced at first intercourse? Lack of clarity about what one wants sexually, rooted in corfusion, sharne and cuftural ambivalence about teenage sexuality, undoubtedly contributes to miscommunication between sexual partners and sexual coercion. The young age at which many Anguillians begin

39~herewere ihrec possible respollscs to the question "The first time you had ses were you pressured into it against your will?": yes, sort of, and no. Yes and sort of wcre coded as ycs responses. While almost twice as many girls as boys reported some type of coercion at first intercourse, a greater percentage of young men answered "yes" as opposed to "sort of". Twenty+ne percent of young men as opposed to twelve percent of young women reported straightfonvard coercion. Forty-nine percent of girls said they were "sort of" presswed into have sex for the fkt timc, while only fourteen percent of boys chose this rcsponse. It is diff~ntltto explain the greater percentage of boys who report direct coercion at fïrsî semai intercourse. 1 speculate constructions of rnasculinity may cause boys to be more vocal in the sexual interchange, making their ycs or no clear. Girls, on the other han& may take rcsponsibility for the sexual desirç or bchaviour of their priitncrs, and thus unwanted sex, leading them to report th- were ody "sort O£"pressured. The dynainics that wouid lead a girl to say she was "sort of" coerced are weU dcscribed by Tolman and Higgins: "Was lenny raped? Jenny herself brings the word "rape" into her story: '1 mean 1 wuldte said no, I guess and I could've pushed him os or whatever 'cause he, I rnean, he wasn't, he's not the type of person who wouid Idce rape me, or whatever. 1 mean, wellI don't üiink he's that way at ail.' ...Although she stopped saying no and apparently assentai nonverbally to the act, îhis sexual experience was not relatai to any fcciing of yes on Jenny's part"(To1man and Higgins, 1996,2 16). having sex is also a concem, both in ternis of their physicai and emotional development. Further, the power dinerential engendered by the large age gaps between Anguillian youth and their first sexual partners probably contributes to sexual coercion. Du~gchildhood and adolescence the developmental gap represented by three years is considerable. For example, the daerence in emotionai and inteilectud rnatunty between a fourteen year old and a seventeen year old, regardless of their physicd development, is large. Given the development dserential of a three year gap, it is significant that the first semai partners of forty-percent of the respondents were more than three years older than the youth. Furthemore, among those whose sexud debut was with an older partner, thirty-percent experienced fht intercourse with someone more than ten years older than themselves. The data fiom the Adolescent Reproductive Health Survey correlates large age differences between partners and sexual coercion. Among youth whose kst sexual partner was younger, their age or less than ten years older, forty-three percent report coercion. In contrast, seventy percent of the young people who experienced intercourse with someone more ten years older than themselves reported coercion. The coercion reported at first intercourse was collected separately fiom information about senial abuse, as sexual abuse is often not intercourse but unwanted sexual touching. The question defined abuse broadly: "Has anyone ever forced you (physically or with words) to do something sexual that you didn't want to do?" In total, thirty percent of the respondents reported sexual abuse. Respondents were not asked about the form the semai abuse took, but thirty-three percent of those who reported abuse did not report having had sexual intercourse.

Addressing the Gaps Between Ideals and Realities Anguiliïan young people aspire to the sexual ideals of their community, yet they are not convinced their peers and role models conform to the Christian ideals held up as the standard for good living. The vast majority of Anguiliian youth agree that delaying sexuai activity until marriage or graduation from high school is valuable, yet forty-one percent of the representative sarnple of young people attending secondary school reported having had sexual intercourse. Nearly haIf of the forty-one percent who reported having had sex also reported being coerced at first intercourse, suggesting that under other circumstances, they would have deiayed sexual activity. The role of sexuaily predatory adults in the sema1 expenence of children and teenagers does much to destroy the myth of teenage sexual irresponsibility. Teenagers may not be making the best sexual decisions, but those decisions are made within a cultural context and social relations which do not support the best decision making. It is a chailenge to the medical and educational system, parents and other socialking institutions such as the churches, as well as the youth themselves to bring the realities closer to the ideals and thus ensure Anguilla's good heaith. While the HIV/A[DS pandemic has not dected Anguilla as it has some of the other islands of the

Caribbean, the presence of AiDS in the local population (Rogers, 1998), vectors of infection through immigration, emigration and travel, and the unsafe sexual practices reported by young people make the devastation that has occurred elsewhere a distinct possibility for Anguilla and underlines the urgency of addressing adolescent smdand reproductive health. Doing so means entering into a fiank dialogue that recognizes that young people agree with the sexual ideais that characterize Anguilla, and seeks ways and means to help Anguillian youth turn those ideais into realities. The foiiowing anaiysis focuses on reproductive and sexual health education and service delivery in the public system. Parents, pastors and peers al1 have an important role to play in ensuring the sexual health of Anguillian youth, but the public system is the sole apparatus that can establish and evaluate a standard level of service, and ensure universal access. The following sections evduate the current use of sexual and reproductive health education and services, barriers to use, the preferences of young people for education and service delivery and make recornmendations. It is my contention that meeting the sema1 and reproductive health needs of Anguillian youth wiil not demand a large influx of new resources. Political WU,reconfiguration of resources cunently available and strategic hiring for positions for which rnoney has already been allocated cm make significant improvements.

Sexual and Reproductive Heaith Education Fear is fiequently expressed that educating young people about sexuality will encourage them to experiment. Reviews of the effects of sexual health education in North Amenca and intemationally demonstrate that sexuaiity education either does not affect age at kstintercourse or increases the age at first intercourse." Programs that are limited to encouraging abstinence tend to instiii favorable amtudes to abstinence but are shown to have Little effect either on the age at which young people become sexually active or the protective steps taken at first or absequent sexual intercourse (Olsen et al, 199 1; McKay, 1993). In contrast, comprehensive sexual health education, that is education which teaches abstinence, contraception, and communication sus, has been shown to delay first intercourse, reduce number of partners, increase condom use, increase the use of contraceptives by females and reduce sexually transmitted diseases and pregnancies (McKay, 1993; Ma& 1994; Hofferth, 1991 ; Nitz, 1999; Grunseit et al, 1997). Given that sexual health education is not shown to encourage eariier sexual activity and that young people need to know about sexuality, reproduction and contraceptives in order to make informeci decisions, high quality, comprehensive sexuality education is an important goal. The curent knowledge levels of Anguillian youth demonstrate a need for improvement. Knowledge of HIVIAIDS Anguillian youth know that HIV/AIDS cannot be transmitted through casud contact but do not have the awareness of heterosexual transmission or confidence in the efficacy of condoms, which could help them assess and reduce their risk. Seventy-one percent of the respondents stated that you cannot become infected with HIV through mosquito bites. The awareness of secondary school students that HIV cannot be transmitted by blood sucking insects is ten percent higher in 1998 than it was in the general populdion in 199 1 (CAREX, 1991). However, the tendency of adolescents to associate HIV/AIDS with homosexuality suggests underestimation of risk. Slightly more than haif of the respondents realized that AIDS is more cornmonly spread through heterosexual than homosexual sex. In fact, heterosexual transmission dominates worldwide; in the

400ne review article notes that one ataluation of a "knowledgeonly" sexual education program found that youth who had a sex education course at a young agc were more likcty to initiate sexual acîivity at ages nftecn and sixtccn but not at oIder ages; a second study refit4 this finding (Hofferth, 1991). A later review article look4 at fitty-two studies. Gninseit and her colleagues found three cases wherc se-nialityeducation was associated with increased or carlier sexuai intercourse, seventeen cases wherc semiality education delayed the onset of sexual activity, reduced ihc number of partners, reduced the nurnbcr of teenage pregnmcies or reduced the incidence of STDs in the population, and twenty-five cases where sex-uality education was not associated with any effèct (Gninscit et al. 1997). English-speaking Caribbean heterosex is estimated to be responsible for more than eighty percent of new infections. Biblical judgements of homosexuaiity and the description of HIWAIDS as a plague are a stumbling block to dealing effectively with HIVIAIDS in Anguilla. These associations stigmatize HIVIAIDS, suggesting the disease is a punishment, and by logicai association., that those who become infecteci "deserve it." Stigma represents a barrier for treating al1 sexualiy transmitted diseases but may be particularly large for HIV/AIDS because of the erroneous association with homosexuaiity in a homophobic ~ociety-~lStigma can discourage individuais from adrnitting they may be at risk, testing for HIV if they feel they may be at risk, or revealing their HIV status to their partners or the larger comrnunity in an effort to prevent fbrther infection. In short, associations between homosexuality and HIV/AiDS fosters risk denial, which in tum promotes the spread of the virus. The construction of HIVIAIDS as a disease that affects and infects "other people" is particularly dangerous because the prime risk reduction strategy reponed when heterosexuals are asked how they have modified their sexual behavior in response to the HIV/AIDS pandemic, is choosulg partners they believe to be "safe" rather than using condoms (Metts and Fitzpatrick, 1992). The fact that only slightly more than haif of the youth were cognizant of the predorninance of heterosexual transmission highlights the need for more education about the history, epiderniology and social issues associated with HIV/AIDS. In tems of preventing the transmission of HIV, fifty-nine percent of the respondents stated that condoms provide very effective protection against HIVIAIDS. While abstinence is the only way to be completely safe from pregnancy and risk of infection with semally transmitted disease, when properly and consistently used, condoms corne a close second. A study of two- hundred-and fifty-six sexually active, serodiscordant heterosexual couples tracked for a median of

41 The association of "healthy"with "normal"and "diseased" with "daiant"(Waldby, 1996) overlaps with homophobia and is compounded by the long tradition of associating STDs with compt sexuality: "venereal disease came to be seen as an fiction of those who willfully violateci the moral code, a punishment for se.d irresponsibility" (Brandt, 1985, 5). The long history of constructing sexdly transmitted disease as "foreign"or belonging to the "other"is iiiustrated by the nama uscd for SJphilis during the 19th century: "to the Germans it was a "French"disease; to the French it was the "Itaiian"diseasc; the Japanese called it the "Portuguese"disease ..." (Nelkin and Gilman cited in Emkc, 199 1, 216). Fear and stigrna associated with sexually transrnitted disease make it emotiody desirable for people not to consider themselves at nsk, and the consuuction of the disease as affecting the "other"supports lhis cognitive strategy 22 rnonths found that none of the HIV-negative partners in the one-hundred and twenty-three couples who used condoms consistently seroconverted; arnong the one-hundred and twenty-two couples who used condoms only intennittently, twelve of the HIV-negative partners became IW- positive (Hatcher, 1994, 56). As about forty-percent of the in-school population reports havhg had sexual intercourse and only haif of these individuds report using condoms consistently, persuaduig young people about the efficacy of condoms is an important strategy for preventing the spread of HTV/AIDS.

Knowledge of Fertility and Contraception Considerable numbers of young people minimized the likelihood of a woman becoming pregnant and overestimated the dangers of hormonal contraceptives. Fo rty-seven percent of the respondents underestimated the probability of a sexually active woman becoming pregnant, and sixty percent were not able to identify the most fertile period of a woman's menstmal cycle. These findings suggest that for youth to better gauge the probability of pregnancy or to employ natural methods of fertiiity regdation, knowledge of reproductive biology must be Uicreased among both girls and boys. It is suggested the pedagogical techniques be altered or classes be evaluated more rigorously because the dierential knowledge levels of those who have taken reproductive biology and those who have not are negligible. Just as young people underestimated the efficacy of condoms, they overestimated the risks associated with hormonal contraceptives. Fifty-two percent of the sample beiieved in error that taking hormonal contraceptives entails more health risk than ~hildbearing.~~The combined underestimation of the probability of pregnancy and overestimation of the dangers associated with oral contraceptives may discourage young people fiom thinking seriously about contraception.

42~lobally,because of inadquate health Gare Uifranncture, early age at fint pregnancy, etc. giving birth entails more health risk than taking hormonal contraceptives. 1 rcagnize cornparison between the risks of childbearing and hormonal contraceptives is frequently used to dowvnplay the health risks and side effects of hormonal contraceptives and justify their promotion. This \vas not my intention in asking the question. 1 believe semai and reproductive health providers and advocates should depart from women's decision to becorne pregnant or no& and then work towards proMding a wide range of safe choices to support childbeariag or contraception (WEMOS, 1992, 12). The comparison is not meant to justify limiting women's range of contraceptive choices or providing sboptimai health care. The question is meant to provide an indication of young people's perception of the immediate health risks associateci with contraception and childbearing. In terrns of access to contraceptives, fifty-seven percent of the respondents were aware

that teenagers cmget fiee contraceptives at public health clinics. More than haif of the youth population being aware of the services currently available to meet their reproductive and sexual

health needs is a partial success. There was little variation in awareness of these services between young people who have been sexually active and those who have not. However, boys were much more likely than girls to be aware that fiee contraceptives were available to thern (seventy-two percent as oppose to fifky percent). Nurses and Health Educators have mentioned repeatedly that boys are less shy than girls about asking for condoms. In fact, heaith service providers indicate that boys use the possession of condoms as a symbol of their sexual experience in order to enhance their school yard bravado. Thus, the greater awareness of young men about access to contraceptives may be a tiuiction of greater social acceptance of young men than young women being sexually active. The sexual double standard, gendered sex roles and physical logistics of condom use d contribute to men's greater ease in using condoms. These factors provide strong arguments for health promotion and family planning seMces to expand beyond the adult women who have traditionally been targeted for education and services. Establishing condom use as normative when men are young will not oniy protect adolescents but would have long-tenn benefits for preventing the spread of sexually transmitted infections in Anguilia. Educating for Sexual Planning In both the case of preventing pregnancy and preventing sexuaiiy transrnitted infections such as HnrIAIDS, it is weii accepted that knowledge is a necessary but not sufficient condition for the reduction of nsk behavior. In other words, knowledge does not necessarily translate into behavior change (Barling and Moore, 1990, 883-884). This is because sexual decision making is not purely an inteliectual activity. Cultural norms, perceptions of peer behavior, physical and emotional needs all influence decisions Witz, 1999,458). Thus, the muent failure of young people to plan for and manage sexual activity can be attributed to the interaction of developmental stage and culture. Al1 contraceptives require thinking ahead, and some researchers have suggested that the planning abilities necessary to successfuliy and consistently use prophylaaics are not attained by most young people until around age sixteen (Hatcher et al, 1996, 59-60). The challenges codronting adolescents in tems of developmental stage are compounded by prohibitions against or denial of adolescent sexuality, which discourages consideration of the possibility of sex and also the possible outcomes. Kadolescents are not supposed to be thinking about sex, then being "swept away in the heat of the moment" or "madly in love" (being in a state where one is incapable of thinking about the sexual act or its consequences) provide explanations for why the forbidden occurred. Given social condemnations of adolescent sex, it is not surprising that seventy-five percent of the respondents reported that their £ktsexual experience was unplanned ("it just sort of happened"). The faiiure to plan or manage sexual intercourse may also have a gendered aspect- The semal double standard makes female sexual activity unsanctioned by marriage less acceptable, while simultaneously holding women moraiiy responsible for sex and practically responsible for contraception. The gender bias against women planning sex is supported by the Anguiilian data; only twelve percent of girls as compared to twenty-one percent of boys reported planning their first intercourse. In order to compensate for developmental stage of adolescents and counter confusion created by cultural ambivalence about adolescent sexuality, sexual health education must do more than sirnply inform adolescents about sexuality and reproduction. Guiding adolescents to think about sex in terms of what it could mean for their lives may act as a deterrent to intercourse by exposing the complexities and problems that accompany becoming sexudy active. Educational programs that combine information with skill-building aimed at negotiating difncult interpersonai situations have been demonstrated to be more successfùl than programs that focus on knowledge alone (Rotheram-Bonis and Koopman, 199 1; Winter and Goldy, 1993 ; Nitz, 1999). In addition, the interpersonal communication skills and goal setting, which are integral to skills-based sexual health education, will be valuable in ail spheres of an adolescent's Me. Commuaication Channels Having established the importance of and need for more comprehensive and skills-based sexuality education in the Angudhan public education system, we must consider who would be the best to teach this curricuium. WMe the important effect peers have on sexuai attitudes and knowledge was demonstrated by the fact that "fnends" was setected trvice as fiequently as any other category when asked "who do you talk to about se^?"^^ Anguifian youth expressed a strong preference for conventional sources of information about sexuality and reproduction. Seventy percent of the respondents indicated the best way for them to get general information about HTV/AIDS, pregnancy, sexuaîiy transmitted diseases and puberty was in school through personal and social education and guest speakers. The strong preference for classroom instruction may be associated with the ability to gain knowledge without self-disciosure. in terms of getting answers to specific questions about sexual and reproductive health, young people again turned to "traditionai" sources of information: twenty-six percent chose heaith ducators; twenty-six percent indicated a nurse or a doctor; twenty-two percent would prefer to speak to their parents; thirteen percent would like to discuss with their peers; and thirteen percent chose other sources of information. The preference of Anguiiiian adolescents for cIassroom instruction and professionai health service providers suggests resources for semai heaith education shouid be focused in the classroom and the clinic. Establishing the content for delivery in the classroom and identifjing the most appropriate educators will be one of the foremost tasks for the multi-sectorai working group which is to be established out of the current consultations. It must be recognized that sexual health education is a particularly dficult teaching area because of the moral and cuItural issues it raises. If sexual health education continues to be taught by general classroom teachers as a component of persona1 and socid education, these teachers wiil need training and cumculum support such as prepared course materiais and audiovisual aids. Anguilla also has a grest resource in the positions of the heaith educators and the family Me educators, who have been trained with the assistance of the

43~hcfact that nineteen percent of the respondeats said ùiey did not taik to anyone about sex is indicative of the barriers to speaking about sexuality and accessing sexuat and reproductive health information. United Nations Famiiy Planning Association. Efforts should be made to ensure the specialized skills of these individuals are being utilized within the education system. Furthemore, the health education department should readjust their pnonties to provide more face-to-face instruction in the secondary school. The health education department has three fùll-time employees, the quivalent of fifteen working days every week. Currently, three of these days are spent in the elementary school system and none are specifically dedicated to secondary school students. Given adolescents' stated preference for face-to-face instmction in the classroom, it seems reasonable to readjust the tirne allocation of the health education unit so that secondary school students have greater access to health educators. Adolescents' stated preferences for communication channels dso suggest the need for recor@gu~gthe allocation of resources inside the health education unit. Currently, a considerable portion of the human and material resources are dedicated to the production of print materials. The low level of motivation to read reported by secondary school students indicates p~tis not the best channel for reaching this population. Only twelve percent of the students surveyed chose pamphlets and posters as their preferred means of receiving information about sexual and reproductive health. Books and magazines were the least cited way that young people say they leam about sex. Print materids are valuable because they are non-invasive and provide a high level of detail, but low motivation to read indicates prht materials should be used to supplement other communication channeis. In addition, because the Angurllian media is news hungry, health educators have easy access to the population via local radio and newspapers. Instead of producing pnnt materials, the health education unit should focus efforts on face-to-face education and dissemination of information through local mass media. Beyond the classroom and the mass media, the library and non-broadcast video are the most promising communication vehicles. Despite general disinterest in reading as a means of gathenng information, the library is a central social gathenng place for AnguiIlian youth. Until another youth center is established, the library will be a key area for the dissemination of information aimed at this population; a display left in the library foyer for two to three weeks would reach about eighty percent of the student body. This makes the library the most effective communication point identified. Non-broadcast video is another promising option. The production values necessary to compete in the world of broadcast television and low youth viewership of locaily produced shows make broadcast television unfeasible. In settings with captive audiences, such as the classroom or a chic waiting room, video could be an extremely effective educational tool.

Parents as sexuality educators

The results of the National Adolescent Reproductive Health Survey agree with studies from around the world which suggest adolescents want more opportunities to discuss sexuality,

reproduction and relationships with the important adults in their lives (UNAIDS, 1998~).In Anguilla, sixty-five percent of the adolescents surveyed expressed a desire to comrnunicate more about relationships and sexuality with their mothers and forty-one percent wanted increased cornunication about these issues with their fathers. Gender dissagregated percentages provide a more accurate expression of interest. Half of the maies expressed an interest in increased discussion about sexuality and relationships with either their father or their mother. On the other hand, girls expressed a strong interest in talking about these issues with their mothers (seventy- three percent said yes) and an equally strong aversion to embarking upon these topics with their fathers (sixty-two percent said no). Supporting parents and children to open the Luies of communication is an important strategy. Parent-child communication has been to shown in other studies to have a strong protective effects for adolescents' sexuai behavior (Aved and Lobdell,

1984, 292), and this phenomenon was demonstrated in the National Adolescent Reproductive Health Survey. Parents play an important role as sexuality educators not so much through the factual information they provide but as role models and part of their children's support system. Knowledge levels of adolescents who reported speaking to their parents about sexuality and reproduction and those that did not do not differ significantly. Respondents who reported discussing how pregnancy occurs with their parents were no more knowledgeable about female fertility or the efficacy and safety of contraceptives than their peers who did not report discussing this issue with their parents. The foiiowing information was evaiuated: perceived dety of the birth control pill compared to the health risks of childbearing; knowledge of the availability of fkee contraceptives to adolescents in Anguilla, the probability of pregnancy; and abilîty to idente the most fertile period of a woman's menstrual cycle. Children who stated they had discussed pregnancy with their parents scored slightly lower than those who had not discussed pregnancy with their parents. This is probably related to the fact that children who discussed pregnancy with their parents tended to be slightly younger than those who did not report discussing pregnancy with their parents. However, the age merence is not enough to explain the striking similarity in knowledge levels between children who report discussing sexuality with their parents and those who do not. Comparable knowledge levels indicates "factual"uiformation given to children by parents is either incorrect or is not lemed by children. in contrat, sexual and reproductive health education in the schools is shown to markedly increase knowledge levels, highlighting the importance of providing such education to children in the public system. The importance of parent-child communication is demonstrated in the sexual behavior of adolescents and not in their knowledge levels. In the twelve-to-fourteen year-old age range, having discussed pregnancy with parents was strongly correlated with not having had sex. Twenty-one percent of adolescents who reported having spoken to their parents about pregnancy stated they had had sex in cornparison to forty-three percent who did not report discussing pregnancy with their parents. Among the fifieen-to-sixteen-year old youth, those who had discussed pregnancy with their parents were slightly more likely to report having had intercourse than those who had not: fifty-eight as opposed to fifty percent of this age group. While the findings for the older age group are quivocal, reports of younger students are strong evidence that speaking about sexuality and reproduction with parents protects young people fiom engaghg in early sexual advity rather than encouraging it. The protection offered by communication in the family is more evident when we consider more general indicators of familial communication than specific discussions of sema1 and reproductive health. For example, respondents who indicated "my famiy understands me" were much less likely to have had sexual intercourse than those who disagreed with this statement. Likewise, respondents who said they could tell their mother any of their problems were less kely to have had sema1 intercourse than their peers who did not feel as able to confide in their mothers. It is not possible to state with assurance that this is not a chicken and egg scenario in which the dficulties presented by being sexuaiiy active are those which young people do not feel comfortable discussing with their parents. There were correlations between unwiilingness to disclose health status to a parent or the adult the adolescent lives with and sexual activity. Twenty-two percent of adolescents who had been sexually active said they would not disclose any type of health problern to their parents as opposed to fourteen percent of children who had not

had sex; age of the respondent was not significant. In the sarne vein, thirty-two percent of sexuaiiy active adolescents would not take an HIV test if their parents were informeci, whereas only eleven percent of virgins indicated the doctor or nurse informing their parents would stop them fiom getting tested. The descriptive nature of the Adolescent Reproductive Health Survey does not permit explanation of why adolescents who are sexualiy active are less likely to confide in their parents about their health status. The findings about the protective nature of parental communication suggest the importance of programs that wiil provide opportunities for young people and their parents to begin communicating more openiy about sexuality and in general. At the same tirne, the reticence of some adolescents, particularly those who have been sexually active, to comrnunicate with their parents about their health status emphasizes the need for youth- friendly sexual health education and seMces through a public system. in conclusion, 1 have themajor recornrnendations for the improvement of sexual health education in AnguiIla. First, an intersectord working group composed of aH of the interested stakeholders, including youth, needs to establish a comprehensive, reguiarized and evaluated

CU~CU~U~for sexual health education, including the primary schools. Education with a strong experiential and skiiis-building approach has been demonstrated to be significantly more successfüi than a purely didactic approach. Therefore, this approach is recornmended. Contiguous with the development of this curriculum, awareness of the benefits of comprehensive sexual health education needs to be fostered. Parents, teachers and peers who may be involved in cumculum deliveiy wiil be particularly important audiences for these messages. Finally, there is a need to reallocate priorities and responsibiiities within the Health Education Unit so that staff can devote more tirne to face-to-face education with secondary school students and to information dissemination through the mass media.

Youth and the Public Hdth System The most successful sexual health interventions with adolescents have offered integrated sexud health education, skills training and service provision. One of the success stories mentioned most fiequently in the literature is a school-based program in Baltimore that provided classroom instruction, presentations during lunch and home roorn periods, group discussion (with peer facilitation) and individual consultation. The same nurse and counselor who provided the educational component offered ind~dualcounsehg and contraceptive senices in the mmmunity clinic across the street fkom the high school. Pregnancy rates for adolescents involved in the program dropped thirty percent, while the pregnancy rates among the control group increased by nearly sixty percent (Hofferth, 199 1, 9; Nitz, 1999, 462). The Anguillian public health care system is in an excellent position to achieve similar outcornes because the Heaith Education Unit already provides a physicai and hurnan bridge between the school and the chic system and because adolescents look to the public system to meet their health care needs. However, the Adolescent Reproductive Health Survey aiso suggests that current barriers, such as logistics of service delivery and perceptions of the seMce providers, must be removed before young people will access reproductive and sexual health care services. Many of the senrice providers interviewed dunng the needs assessrnent stated that youth did not have much contact with the public health system. The self-reporting of youth contradicts this perception in that seventy-six percent reported attending a public chic for medical services, and sixty-six percent had visited the Princess Alexandra Hospital since beginning high school. Less than halfreported having used private medical senices in Anguilia or off-island. The contact adolescents have with the AnguiIlian public health system represents a responsibility and an opportunity. Most young people dldepend on the public heaith system so it is important that services are designeci and delivered in a manner that meets their needs. The contact is an opportunity to show young people that the public health system is receptive to them and provides high quality services. If the treatment provided for a broken arm, cut, or throat infection is respecthl and competent, the confidence built will encourage youth to return with more optional and sensitive heaith needs such as those pertaining to sexual and reproductive health. With respect to sexual and reproductive health, the perception that adolescents access sexual and reproductive health care services outside the public system, most ofien in St. Marhn or fiom pnvate doctors in Anguilla, emerged strongly from the needs awssment. Service providers attributed avoiding the public system for these health needs to stigrna associated with semal and reproductive health and adolescent fears about confidentiality; several public health nurses reported that adolescents who do access reproductive and sexuai health senrices in the public system wilf travel to a different district in an attempt to conceal their activity. The reasons why youth woufd seek reproductive and sexual health care offisland are demonstrated in fears about confidentiality and perceptions of the attitudes of Anguillian service providers. Concerns about confidentiality and negative judgment do represent barriers to Anguillian youth meeting their sexual and reproductive health needs, however, despite this, seventy-six percent of the sexualiy active youth who report any kind of sexual and reproductive heaith care services or information indicate they went to the Anguillian public health care system. Where concerns about confidentiality and negative judgment manifest themselves is in that only skty percent of those who have had sex have sought sexuai and reproductive health care or Somation fiom either the pnvate or public system. This number corresponds roughly to the number of sexually active youth who report using birth control and protecting themselves fiom sexually transmitted disease with condoms. About forty percent of the young people who have had sexual intercourse are not accessing information or services and are not protecting themselves from the consequences of sexuai activity. Among those who have not had sex, a little more than halfrepon having sought out information or advice about sexual and reproductive health- Studies fiom the United States indicate that most adolescents do not seek reproductive heaith care services until approximately one year after becoming sexually active, and fi@ percent of pregnancies occur in the fist six months fier the initiation of intercourse, with twenty percent of them occuring in the first month alone vatcher et al, 1994, 580; Jemmot and Jemmot, 1996, 396; Nitz, 1999, 46 1). The ultimate goal would be to have most young people discuss their semal health options with a health care seMce provider before becoming sexually active or shortly thereafter. In order to meet this high standard, the health care services on Anguilla will need to become more "youth fXendly." Creation of a positive relationship between youth and the public heaith system will allow the Prïmary Health Care Department to effectively meet its mandate of preventing unfiealthy Mestyles by educating and empowering the population to make healthy choices (Health Education Unit, 1998). The Angufian Primary Health Care system has some excellent programs and protoçols in place to meet the reproductive and semal health care needs of adolescents. For example, condom distribution through work sites and the Health Education Unit on the grounds of the Albena Lake Hodge Comprehensive School is the envy of many health promoten throughout the Caribbean (Interview with health educator, December 6, 1998). The telephone hotline and past youth involvement in planning and delivering health education are assets. Finally, while historically there has been lack of direction eom the Ministry of Health and reticence on the part of nurses and health educators to provide contraceptives to minors, the absence of legislation forbidding such provision is an asset (UNFPA, 1984, 62). In order for these programs to revive and Mll theu potential, two major barriers to youth accessing reproductive and sexual health care seMces need to be addressed. The current barriers can be divided into two main categories: the logistics of seMce delivery and perceptions of service providers. Logistics of Service Delivery In general, hdth services are not being delivered at times and in locations amenable to young people. An example of how a seMce that can be very youth fiiendly is being delivered in a way that presents barriers to youth access is the National AIDS Hotline. The hothe is operational on and off between eight in the morning and four in the aflemoon. Less than ten percent of respondents indicated they would cda telephone information line during working hours. This means that the service, as currently oEered, is not likely to be accessed by approximately ninety percent of young people. Likewise, public clinics are open during working hours and generaliy closed for lunch. This responds better to the needs of in-school youth as thirty percent indicated the best time for them to visit a health clinic on their own would be during working hours. Lunch hour and after school(3:30-530 pm) were also popular options with forty-two percent of the students selecting one of these tïmes. Tt would be possible to cater to the schedules of more than seventy percent of the young people by holding a youth ciinic fiom 1 1 :30 in the morning to 5:30 in the aftemoon. The extension of working hours in the afternoon seems more feasible than hahg staff attend in the later evening or on weekends. In terms of a location for a health chic for youth, the Valley was considered the best option? Sixty-six percent of the respondents indicated that the Vdey or the secondary school would be the best Iocation for a youth clinic. The Health Education building is a naturai selection as it was constructed on the grounds of the Albena Lake Hodge Comprehensive School by the Pan American Health Association specifically to tùnction as a Family Life Education and Fady Planning Clinic for youth. The building now fiinctions as office space for one of the health educators, the graphic artist and the school nurse. The logic of housing these stamembers in this building is clear as they are working with the school-age population. However, services are not being offered to adolescents fiom this site, and adolescents are not accessing the pamphlets and other information that is avdable at the Health Education Unit. There are usually several students on the steps in fiont of the building but rarely any students inside. In short, the building is not fulfilling the purpose for which it was built. Operationaiizing the Health Education building as a clinic would involve some dislocation of the people working there currently, particularly on those aftemoons when the chic was actuaily fiinctioning. However, it seems reasonable to expect the health educator and school nurse could be directly involved in the delivery of the youth clinic or working out in the schools or the cornmunity during the youth clinics. Perceptions of Service Providers While the logistics of service delivery, particularly the establishment of an operational youth clinic in the Health Education Unit, would greatly improve access to sexual and reproductive health services, I am forced to agree with the aatement that for adolescents in the English-speaking Caribbean, access to contraceptives are " less problems of physicai and

44The Valley is the administrative and cornniercial antre of Anguilla. The secondary schwl and main governent buiIdings, including primary healih care and the library, are located in the Valley. economic access and essentially problems of social psychological access" (UNFPA, 1984, 25). It is quite reasonable to assume that young people's perception of health seMce providers as not keeping confidentiality and passing negative judgments on sexually active youth act as deterrents to seeking reproductive and sexual health services. Confidentiality Youth have grave concerns about the confidentiality of medical services. Only twenty- three percent of the respondents were fully contident that doaors and nurses in the public health system would maintain confidentiality. Twenty-two percent expressed some confidence that personal information disclosed to a health seMce provider would remain private. Slightly more than halfof the respondents had no faith in the confidentiality of the public medical system. Whiie confidentiality of personal health information is important for everyone, adolescence is a time when privacy is highly, perhaps even obsessively, valued. The sense of immortality and belief that "it won't happen to me" are stronger during adolescence than later in Me, diminishing the perceived benefits of seeking medical assistance or advice. Basicaily, the risks are perceived as too high and the benefits as too low. Untii young people are convinced their privacy wiil be respecteci, particularly with regards to sensitive areas such as sexuality, they will simply not seek out services. There are, however, examples of sites in the Anguillian public heaith system that garner greater confidence among adolescents. For exarnple, sixty-four percent of the respondents concluded that HIV test results would be kept confidential. The higher confidence level invested by the respondents in the iab stafFwith regards to HIV testing than to nurses and doctors generaily attests to the potential for building a good reputation arnong health care consumers by offering high quality se~ce.The Adolescent Reproductive Health Survey is a testimony to the high priority that must be accorded to implementing stringent protocols for handling records and disciplinary action for breeches of confldentiality. Negative Judgment Youth reluctance to seek sexual and reproductive health care services because of fears about lack of confidentiality are compounded by the expectation that the se~ceprovider wiii judge them negatively. More than eighty percent of the respondents disagreed with the statement:

"Doctors and nurses thhk teenagers hakg sex is OK." There is a considerable difference in opinion in this regard between young people who have been sexuaiiy active and those who have not. It is ençouraging that young people who have been sexually active, and perhaps corne into contact with health service providers as a consequence of that sexual activity, were more likely to agree with the statement. However, seventy percent of those who had had sex and ninety percent of virgins felt doctors and nurses disapproved of teenagers having sex. In part, the belief that health seMce providers wiU judge sexuaiiy active youth negatively corresponds to the young people's own belief that teenagers should be sexually abstinent until marriage or graduation fiom hi& school. The gap between the ideals of teenagers and their sexual realities is one which health service providers must help adolescents bridge. Non-judgrnental education of teens and provision of seMces is a sensitive subject because no one wants to condone teenagers having sex outside of marriage. On the other hand, ambivalence, shame and censure make it difficult for young people to get the information they need to make sexual decisions that are less risky to their health. The bottom line is that ignorance does not prevent adolescents fiom having sex. Ifa young person is thinking about becoming sexualiy active or is sexually active, then it is essentiai they are informed about their options so they can make responsible choices about how to safely express their sexuaiity. Valuing the maturity of adolescents who seek out sexual and reproductive health care services and information is an effective response to the reality of Anguillian adolescents' sexual behavior. My recommendation for improvuig reproductive and sexual heaith service delivery is twofold. First, estabbshing a multi-purpose youth clinic. The first priority in the UNFPA Regional Action Plan for Adolescent Sexual and Reproductive Health and Rights, to which Anguilla was Party, was estabiishing youth clinics by the year 200 1. The comprehensive chic has the double advantages of not making the reason for the visit immediately apparent to the client's peers or school stfland teaching the adolescent to use the chic system for al1 their health care needs. The site could also be used as a base for other youth activities such as peer counseling and other hedth related organizations such as the Junior ADS Committee. The best way to make sure the youth

clinic rneets the needs of young people is to involve a broad cross section of youth in the development of the services. Some general characteristics of teen-niendly seMces are: youth on the fiont line, separate space and entrance for young adult clients, convenient hours for young adults, drop-ins welcome, emphasis on privacy and confidentiality, extra tirne provided for counseting, decor which caters to youth, specific encouragement of male participation, and reduced costs aordable to youth (Lindsay Stewart, Deputy Director, FOCUS on Young Adults Program, Report of the Round Table on Adolescent Sexual and Reproductive Health, New York: UNFP A, 1998. ; Nadia Vaughn, Family Planning Association of Barbados, October 1998; Youth and Community Ciinics-Policy Discussion, Vancouver Richmond Hdth Board Population Advisory Committee of Children and Youth, 1997). Establishing a youth chic that is open in the afiemoon and which operates out of the Hedth Education Unit and involving young people in the design and deiivery of seMces could meet these criteria- The second barrier is establishing a relationship of trust between the youth and the health seMce providers. Some strong relationships already exist between young people and individuals working in the social seMce sector. The Ministry of Social Services has allocated fùnding to hire a second school nurse. It is suggested the seledion committee proceed with perceptions of youth at the forefront of their criteria. Once hired, the individual will no doubt be tested for their ability to respect codidentiality and treat young people in a non-judgrnental fashion. Building a relationship of mutual respect and trust can oniy be achieved through demonstration. Conclusion The report 1 wrote and the presentations 1 made to stakeholders argued for the redefinition of teenage seniality on severd fronts. The moral panic blarned the non-existent crisis in teenage pregnancy on the moral deviance of Anguillian adolescents and used this supposed mord deviance as a signifier of the larger mord decay of Anguillian society. The desired outcome of presenting the survey data was to provide an opportunity for people to perceive the constraints under which Anguiiiian adolescents were making their sexual decisions in a new light and thus inspire people to imagine how these social conditions could be changed: The point of departure of the rnovement lies in the people themselves. But since people do not exkt apart fiom the world, apart fiom reality, the movement must begin with the human-world relationship. ...Only by starting fiom this situation- which determines their perception of it-- can they begin to move. To do this authentically they must perceive their state not as fated and unalterable, but merely as lirniting-and therefore challenging. [.. . ] As the situation becomes the object of their cognition, the naive or magical perception which produced their fatalisrn gives way to perception which is able to perceive itself even as it perceives reality, and can thus be critically objective about that reality. (Friere, 1993, 66) The attitudes about sexuality expressed in the National Adolescent Reproductive Health Survey challenge the assumption that young people are engaging Ïn sexual activity because they have abandoned the moral values of their parents or the "tme Anguilla." The views expressed by young people conform to the Christian values which dominate in Anguiiiian society. Thus, I argued that health education and seMce delivery oriented solely towards convincing young people to abstain would not improve sexual and reproductive health outcomes because young people agree with the dominant moral views. Furthermore, the moral panic constructs adolescents generaliy, and sexually active adoIescents in particular, as deviant. In contrast, the extent of sexual activity reported among Anguillian youth demonstrates that adolescents having sexual intercourse before marriage or graduation f?om high school is a systernic issue. The gap between ideals and realities and the number of sexudy active Anguillian adolescents offered an opportunity to frame teenage sexuality as a sign for the need for sexual healt h education and seMces to better support adolescents in realinng their ideals of sexual abstinence and protecting the health of those who wii1 become sexually active. Evaiuating current outcomes and youth perceptions and preferences for education and services was an effort to indicate areas needing improvement and persuade the audience of the urgency of workïng towards better sema1 and reproductive health for adolescents. The recommendations were offered as a demonstration that should the stakeholders decide to place pnority on this issue, many of the necessary resources were already available. 108

CHAPTER FWE: EVALUATION As with most research instruments, the National Adolescent Reproductive Health Survey, delivered the information it was created to collect. The survey assessed the level of youth contact with health service providers; idenaed preferred channels of communication for sexual and reproductive health information; evaiuated Anguillian young people's knowledge of contraception, fertility and HIV transmission routes; and collected baseline ùiforrnation about the sexual activity of Anguifian youth as established by self-reports. The survey identified barriers to youth accessing reproductive and sexual health services, such as the logistics of service delivery and the perception that many health service providers would not keep information confidentid and would judge sexudy active teens negatively. The survey also provided some insight into the social context for teen sex in Anguilla by articulating the discrepancy between sexual ideals and sema1 practices, reveahg the prevalence of sexual coercion, and large age differences between partners at fkst sexual intercourse. The limited mapping of the social contea points away fkom a reading of sexuaiiy active teens as individual deviants and towards an understandmg of teenage sexuality as a systemic issue. In this respect, the survey disrupted the moral panic's assumption that teenagers are morally compt and indicated a need to examine the social context that is the backdrop for AnguiUian adolescents' sexual activity. From evaluation of the relevance of the survey information solicited fiom service providers and young people during the survey design and the wide dissemination of the resuits in stakeholder meetings and through the mass media, it appears the National Adolescent Reproductive Health Survey provided and publicized the information it sought. Furthemore, the data gathered could be an impetus and a road map for reforming aspects of the public heaith and education systems to better meet the sexual and reproductive health needs of adolescents. In addition, the recomrnendations 1 made identified actions that could be reasonably expected to improve adolescent reproductive and sexud health outcomes without significant input of new resources. In these ways the National Adolescent Reproductive Health Survey successfbiiy responded to the stated research goais. However, in the larger scheme of things, this is neither surprishg nor particularly interesting. The more interesting evaluation is whether the eight months 1 spent in Anguilla contributed in some meanuigfùl way to fùrthering the weil-being of the young people. 1 wili examine three aspects of the project. First, 1 wiil consider the validity of the needs assessment, which led to my focus on adolescent sexual and reproductive health as a priority health need.

Second, 1 wiii look at a variety of masures for evaluating the success of the project at fostering a dialogue that did not reproduce dominant constructions of adolescents or adolescent sexuality. Third, 1 wiil consider how the alliances 1 made and the research methods that were chosen infiuenced the transition fiom research hdings to implernentation.

Criteria One: Validity of the Needs Assessrnent The fïrst question to be answered in order to assess the project is the appropriateness of identeg adolescent sexual and reproductive health as a priority health need. Aware of the tendency of researchers and international developers to misrepresent people and situations in order to construct problems for which they have solutions (Ferguson, 1994, 177; Escobar, 1995,

107), 1 hesitate to assess my project using the assumption that sexual and reproductive health was the most important need of Anguillian adolescent S. 1 tum to Shiva's comment that "Looking does not create properties, but it definitely creates conditions for their perception" (Shiva, 1992, 235) as an admission and in defense of the validity of constituting reproductive and sexual health as a need. My commitments and education, and the systemic parmeters established prior to my arrival in Anguilla, interacted with phenomena in the Anguillian social conte- to produce a needs assessment that targeted adolescent sexual and reproductive health. The initial needs assessment did not presuppose the identification of sexual and reproductive health as a priority health issue, but i had expertise in sexual health promotion, an epidemiological picture of the region, and resources which predisposed me to work on this issue. Further, 1 was given a mandate to intervene in the health field. An example of how the dehition of health as the pnority issue for the project prior to my arrival in Anguilla did not dow other issues, perhaps equaiiy or more important to the affecteci population, to receive similar attention was that a large number of stakeholders mentioned the need for a comunity center where formal and idormal youth services could be provideci. This was not an issue 1 was

mandated or equipped to address directly. As a compromise, 1 incorporated the identification of thk need into the recornmendation for the creation of a multi-service youth clinic that wuld provide a range of health services. 1 envisioned the youth clinic as a youth fkïendly space which would house programming directeci at youth and provide a physical location for youth-driven, health-related organizations such as the newiy established peer counseling program and the Junior AIDS Cornmittee.

1 recognize the influence my personal cornmitments and stmchual constraints 1 faced had on the selection of the research topic. However, the evidence 1 gathered and response of youth to the research validate the selection of adolescent sexual and reproductive health as a priority heaith need. AU of the evidence 1 gathered formally and informdy indicated the importance of this issue. When adolescents were asked to ident* priority needs in any social sphere, sexual and

reproductive health rated consistently high (Richardson and Kendali, 1999), and young people responded enthusiastically when asked to participate in the Youth Consultation on Adolescent Sexual and Reproductive Heaith. Criteria Two: Fostering Dialogue Three aspects of the public representations of the survey data and community consultations will be considered. First, the effectiveness of the presentation of the survey data tu

legitimize discussion of adolescent sexuaiity and to provide a safe space where that discussicn

couid take place will be considered. Second, 1 will examine whether the dialogue contextuaiized

and problematized the discrepancy between stated ideds and actual sexual practices in Anguilia or simply reinscribed the pre-existing categories of the mord panic. Third, the extent tu which young people participated in the discussion of the survey results and the representation of this youth participation in media reports of the cornmunity consultations wiU be evaluated. Creating a Safe Space One of the major challenges to doing research around sexuality in Anguilla was the difficulties of talking about sexual experience because discussing sexualiîy would mark the speaker as sexualiy knowledgeable and therefore as a simer or social deviant. It is not that sexuality is not discussed in Anguilla. On the contrary, sex is fiequently discussed in tones of hushed gossip about other peopIeUssexual practices and loudly proclaimed judgments about right and wrong that both contribute to the construction and perpetuation of the moral panic. Sexuality is not discussed as a legitimate public health concern or as a personal issue that can be discloseci Mthout fear of censure. Undertaking research on adolescent sexual and reproductive health helped to legitimize the topic in a number of ways. At one level, the simple fact that a research project about adolescent sexual and reproductive health took place, conducted by a "foreign expert" and supported by the Ministry of Social Services, shifted (at least temporarily, and for some people) the issue away fiom the spheres of gossip and moral panic and into the field of legitimate inquiry and discussion My introduction of the survey to the research participants and the way the survey questions were posed expresseci to adolescents that I considered the issue of sexuality and their experiençes important and worthy of thoughtfùl consideration. The verbal and non-verbal responses of the students demonstrateci to me that in Anguilla youth being asked about sexuality in a non-judgmental and serious fashion was a departure fiom the nom. The silence in the room, clamng questions students asked of myself and the other volunteer while completing the survey, and rate of complete questionnaires suggested the majority of the students took the survey as an opportunity to anonyxnously express their sexual knowledge, attitudes and practices. Some young people went further than simply completing the survey; they modified the questionnaire by crossing out descriptors to make their responses more precise and by wrîting in detaiis and explmations of their sema1 histories, demonstrating that they considered the questionnaire important and took it as a welcome opportunity to share their knowledge and experience (Field Notes7 November 5, 1998). The dissemination and consideration of the results in public meetings and through the mass media further served to legitimize the discussion of adolescent sexuality as a serious social issue which Anguillians needed to consider. The presentation of the survey data in cornmunity consultations made it possible for me and for Anguillians to discuss sexuality and address the gaps between ideals and realities in Anguilla's sexual culture without being stigmatized as deviant or sinfùl. Thus, the swey data provided an entry point into a discussion that revealed more about the sexual discourses and various cultures around sexuality which were operating in Anguilla than the survey itselfcould illustrate. These discussions and the recomrnendations 1 made also provided me with a vehicle to respond to what 1 had learned about Anguilla's sexual culture fiom living in Anguilla and not only fiom analysis of the survey data. The paradox of only being able to maintain my status as a credible researcher, educator and advocate for adolescent sexuality by obscuring my own sema1 history was one of the factors that pushed me away fiom a participatory research method and towards an anonymous pencil and paper survey. Presentation of the survey data and making recommendations pennitted me to integrate my observations and experience as a resident of Anguilla without making myseifor rny social networks wlnerable to social censure. For example, over the eight rnonth penod 1 lived in Anguilla, 1 became privy situations that powerfully illustrated many of the semal phenornena which emerged fiom the survey data and then were contextualized in the public meetings: early age at first intercourse, sexual coercion and gendered sex roles; multiple partners, unsafe sex, and tounsm and work migration as vectors for the transmission of sexuaiiy transmitted disease. It was not possible to discuss the specifics of these situations because the size of the island and knowledge of the researchef s social networks would identG the individuals involved. However, the knowledge 1 gathered as an Anguillian resident, through social networks and my own experience, informeci my analysis of the survey data, the recommendations 1 made, and my interventions during the community consultations. In this sense, the report was written in context. The ability to contextualize the survey data as a result of my residence in Anguilla is a strength of this project and points to the potential dficulties of a researcher fiying in, administering a standard knowledge, attitudes and practices survey, retuniing home to andyze the data and then making recommendations based on this analysis. The community consuItations provided AnguiIlians with the sarne opportunity to make comments Uiforrned by their knowledge of the Anguillian sexual culture without stignatizing themselves or their social contacts. Social constructions of sexuality and the sexual double standard were exploreci by youth and adults during public consultations. In one community consultation, a lengthy discussion about sexual relations between oider men and younger women

occurred. Individuals in this meeting rnentioned the conquistador construction of male sexuaiity in Anguilla, for example "collecting notches on a belt" [enumerating sexual conquests] and young women's attraction to older men who have more materid wedth (Field Notes, February 4, 1999). in the context of the comnunity consultation, these phenomena were fiamed as social constructions and not inevitable and imrnutable outcomes of Anguillian's corrupt morality- Among youth, the sexual double standard, which encourages young men to be sexuaily active fiom a young age and promiscuous while demanding virginity until marriage and sexual fidelity fkom young women was mentioned; one female participant described the situation at the secondq school in the foliowing way: "It's a good thing for a boy to go up to his pardnefi5 [sic] and Say, 1 had she last night"' (Field Notes, February 24, 1999). The survey provided evidence of a sexual culture without being able to explain the complexity of social relations that produce that sexud culture. However, the numbers were crucial because they created a sense of legitimacy and provided a way of discussing the issues without discussing the people and without making the subjects or their social networks visible and vulnerable. Sharing the survey data created breakthrough moments when explanations for certain sexual practices, which usually remained unsaid, were spoken aloud. As weil as providing a safe place to discuss aspects of Anguilla's sexual culture, there were several occasions in public consultations when discrepancies between the ideais for behavior held in Anguilla were expiicitly contrasted with common sexual behavior. Several individuals noted that it is well known that the man sitting next to you in church on Sunday with his wife is sleeping with another woman on Saturday night (Field Notes, Febmary 12, 1999). In a phrase which was most telfing for me, one woman said: "We know of cases of it [incest] happening, but it is not the tme Anguilla" (Field Notes, February 12, 1999). The suggestion that sexual assault, incest, adultery and even adolescent sexual activity are not part of the "true Anguilla" contributes to the

4511pardner"is a cummon Anguillian coiioquiailirm for a fnend It is the quivalent of "buddy"or "brother" or "homcboy."It could be used by females to describe their female friends, or between the genders, but in this case, the girl is descriiing one boy speaking to another boy. persistence of these phenornena on the island. "Tranquillity wrapped in blue"46 and strong Christian values are integrai to the prevalent social construction of Anguilla. However, this is not the only reality which operates on the island. Placing incest in opposition to the "true Anguilla" is part of the bulary (goodhad, savedlsinner, abstinent/sexually active) logic which underlies the moral panic. Frarning as opposites mitigates against dialogue about the relationships between the sexual ideals and semal realities operating in Anguilla and is a barrier to the emergence of ways of thinking which could allow an individual the flexibility of being both "good" and "sexually active."

Admitting tbere are gaps between the stated noms in Anguillian society and the realities seems like an essential fkst step towards being able to analyze and creatively approach the realities. Exploring the many facets of the Anguillian sexual culture and confionthg these discrepancies is an ongoing process. However, more rapid disclosure about sexuality by young Anguillians and health service providers to the health care intem who replaced me may indicate that my project was somewhat successfùl in fiafning sexuality as a legitimate topic and decreasing social fear associated with discussing ~exuality.~~

Redefining the Issues-Deconstructing the Moral Panic As describeci in Chapter four, the strategy employed in the public presentations was to recast adclescents as moraliy upstanding and argue for the provision of sexual health education and services by describing the gaps between Anguillian adolescentst sexual ideals and their sexual behavior. This construction of adolescents directly contradicted the logic of the moral panic in which sexually active adolescents (with the assumption being that most adolescents are sexuaiiy active) are positioned as deviants who signai the moral decay of Angui1lia.n society. Anecdotal

46Thïs is the Anguiila Tourist Board's slogan for desaibing the island. Anguillians are proud of the quiet Life of their island: low crime rate, absence of casinos or formal brothcls, absence of jet skis, etc. 47Afler she had been on the island skx weeks, individuals were describing qxdicinstances of senial assault, abortions, etc. to the intern who replaced me. The first breakthroughs 1 ex-rienced with people disclosing their own sexuai expericnœ or dmiing the semai e'rpericnce of others in specinc terms came several months after 1 anived on the island and greatiy inchafter the publication of the survey data. It is possiile the personal attributes of the health care intern who replaced me is the sole reason for more rapid disclosure. It is also possible that she benefitted fiom my reputation as someone who was sympathetic about issues of sexuality. 1 imagine this reputation as at the level of "girls from Canada who work on semai health issues are non-judgmental and keep confidentiality."1 would suggest the second intem inhcrited a role in the social universe familias to Anguiiiians, with al1 the dcficits and benefits that accmed from my successes and fadures. evidence supports the claim that in some cases, 1 was successfùl in dismpting the categories of the moral panic:

... the infonnation ma& a personal impact on some of the stakeholders. Mrs. Johnson Fighest fevel of management of edzcation besides the Permanent Secretmy of the Ministry of Social Services] shed thaf she was physicafiy upset by the infonnation that had been shwed She felt sachess about the small chitaken. This kind of visceral reaction by n persm in a relative& powerfirl position can support change. Mrs. Johnson's concem cmmake her supportive of the sfakeholders[like schooi counselor and health educator who are aireadj itfonned and dealing with the prob lems on a face- fo-face, &y-to-dLIy bais. Fosterz~tgsupport between the fiont htes (who alreadj know whaî 1s going on) and the bureuucrats (who aIZocate resmrces) is a possible positive comequence of research. (Field Notes, Febmary 5, 1999)

Despite generally constructive discussion du~gthe public consultations, it is impossible to systernaticaily assess how successfùl 1 was in convincing the people who participated. 1 will use five newspaper articles that reported on the findings of the National Adolescent Reproductive Health Survey and the National Youîh Consultation as a demonstration of how the argument I made was reinterpreted in the public sphere of Anguilia and as a proxy masure of how successfùl 1 was at dismpting the logic of the moral pank4* The Anguillian, Anguilla's weekly paper, and The hify Herald, the English language daily in St. Martin, reproduced my argument quite faithfùlly. A two-part series in The Atlguiltian reported on the National Adolescent Reproductive Health survey and the recornmendations. The two articles essentidy reproduced the argument made in Chapter Four. The author contextudized the Anguillian data for rates and age of sexual activity as comparable to the rest of the English-speaking Caribbean and provided the statistics on sexud ideals, sexual realities, sexual coercion, sexual abuse, sexual risk taking and knowledge levels (Pizzocolo, 1999b). 1 am quoted as saying:

Adolescents are very moral and the Anguillian youth do believe that abstinence is the bea option. Another thing is to reconcile this belief with the daily pressures of Me.[ ...] The challenge for the 21st century for Anguillians is to be proactive about

48~eAnguiilion published a story about the Youth Consulation on Febniary 26, 1999, and a two part series on the findings of the National Adolescent Reproductive Health Suntcy (NARHS) (March 26, 1999 and April 1, 1999). The Dai& Herald pubiished a stoq on the Youth Consultation on Febuary 18, 1999 and a story on the fïndings of the NARHS on Febuary 27, 1999. what they want Anguilla to look like in ten years' [sic] identifjing what values to sustain and pursue and how to implement them. (Pizzocolo, 1999a)

In both articles, the author stresses the need for the public system to provide confidentid and appropriate se~cesto youth and focuses on the responsibility of adults "to raise a conscious, self-confident, dignified, respected and respectfil generation and ensure a blessed prosperous future for the island of Anguilla" (Pizzocolo, 1999b). The narrative presented here has the same stress on moral values as the narrative of the moral panic, but instead of condemning adolescents and the families that raidthem, and hearkening back to a construction of the past when such sociai problems did not exïst, the author encourages didogue between youth and adults and looks towards the future. The coverage in The Angzd~ianreproduced my focus on the continuity of Anguilla's moral values as an asset for improving the sexual and reproductive health of adolescents. Ln doing so, the coverage refutes the logic of nostalgia and identification and punishrnent of deviance that characterizes the moral panic. The Dai& Herad provided the statistics and recommendations but wzs more sensationalist than Be AnguiIlian. Titled "Adolescent health survey throws up alarming figures, " the article opens with six paragraphs focused on early age at first intercourse, multiple partners, and sexual coercion before devoting one paragraph to the sexual ideals and church-going of Anguillian adolescents. Whiie the space devoted to the most extreme and negative findings of the survey tends towards the negative and alannist bent of the moral panic, the reporting does not draw a causal relation between moral failure and sexual activity or stigmatize adolescents as rnorally compt. Instead, the article invokes shared responsibility for improving the sexual health of adolescents' by quoting "a senior heaith official" saying: We[adults] must be better role models. When we talk about Our adolescents, we must also look at the attitudes and conduct of adults towards adolescence' [sic] Adolescent health needs to be addressed at several levels - policy, community, family and individual" ("Adolescent survey, " 1999). The shift from constructing issues of adolescent sexuality as binary equations in which sexually active adolescents are both a signifier and sign of Anguilla's supposed moral decay to a consideration of adult involvement in creating the social relations that shape adolescents' sexual realities and shared responsibility for improving sexual health provided a more promising foundation for problem solwig. The picture of young people and the type of solutions put fonvard in media coverage of the Adolescent Semal and Reproductive Health Survey differed markedly from the description of the issue as " boung men] walk[ing] our streets dmnk ...appear[ing] dazed f?om drugs... children who are making children [because] we lost sight of our role as parents" (Petty, 1999). In this respect, the project was successfùl in disrupting some of the conceptual categories of the moral panic. The characterization of youth as a "problem" and the taken-for-granted nature of top-down communication and decision making fiom adutts to young people was merchallenged by youth's participation in the Youth Consultation on Adolescent Sexual and Reproductive Health and media coverage of this event. Youth In Dialogue As they were the subjects of the research, as well as of the education and services which were being argued for, opening a space for youth to participate in a public dialogue about the survey results and appropriate strategies for improving adolescent sexual and reproductive health was crucial. Youth did participate in the dialogue through a day-long Youth Consultation on Adolescent Sexual and Reproductive Health. The priorities and strategies put forward by the youth and young people's ability and right to elaborate such priorities and strategies was represented favorably in the media. Before discussing some of the outcornes of the consultation, it is important to note that the quality of participation achieved at this event was rare. Over the course of the eight-month project, attempts to involve youth in the research and dissemination process taught me that both youth and adults tended to assume instrumental as opposed to transformative participation was being asked for and that elite youth were put forward to fùlfill this instrumental participation. 1 make the distinction between instrumental and transformative participation based on Wright and Nelson, who state: "Getting communities to decide on their own priorities was caiied transformative; getting people to buy into a donofs project was instrumental" (Nelson and Wright, 1995, 5). In Anguilla, the ccmmon structure for detemiinhg participation tended to be top domor institutional in the sense that people aîtended events as part of their work or school day. The instrumental nature of participation, Le., being present because an institution or group must be represented, rather than because of a genuine interest was highlighted for fie by my initial attempts to meet with the Junior AIDS Committee:

The Junior AiDS Committee was preserzted by Mrs. Jones as a youth initiuted project. Sqand Bobby were put forwurd as the leaders. menIfinulfy met Suzy md asked her about the grmp, she said nothing had reulfy been done, and the best thing to do wouid be to speak to Mrs. Jones. Then, when I had an opportunis, to meet with Suzy and a teacher who vohzteered to mentor the group, tkyfelr the wqy to get people involved would be by askittg euch of the youh service orgrnizutions to provicie a represerrtutive. They wanted to get a mmberfiom me, so tht they could eltsure we had a certain nrrmber of people. 1said "no", the number didn't mutter, that wht was important was thut people were realfy interested in the group and had ideas. (Field Noles, September 17, 1998) When the issue of youth participation or youth representation was raised in my project or other youth-related initiatives that 1 observed during the time 1 lived in Anguilla, the "good" youth were always put forward as participants. Eyben and Ladbury write:

In the conventional wisdom of the aid profession: community action is iinked to the smail-scale "traditional" village society where people are not self-interested individuds nor members of socialiy differentiated categories. Homogeneity is assumed and dong with it a population's structured capacity to CO-operatewith those designing and implementing a project. In our view this idealized notion of community is a real barrier to understanding the dynamics of participation and explaining the circumstances in which participation does and does not occur. (Eyben and Ladbury, 1995: 194) 1 have described Anguilla as a "gemeinschaft" or strong tie community, but within this community there are dzerentiated expenences and unequal distribution of benefits and costs. The covering over of difEerence under the word "youth" or "community" and the problems this posed with regards to representation was ciear to me while 1 was in Anguilla:

1have heard [service provider] ly several times thaf it won? do just to send "anyb@" as a delegale [to the WPAYoirth Sununit in Burbadosj. The brightest, most sociuliy acceptedyouth are se fected, or self select to represent young people. ïhey may ulsu be (ihere ore afwaysexceptions) those who me Ieast fïkefy to pructice unprotected sex, to become pregnmzt, etc. (Fiefd Notes, September 22, 1998) While 1 was criticai of the selection process for representing Anguilla at a United Nations

Conference, 1 feil into the same trap in the selection of youth to participate in training for a peer

counseling program (Fieid Notes, December 4, 1998). As an outsider, 1 had limited control over the selection of the peer counselors. Over a period of two months, 1 discussed the criteria for

selection with the Anguillian professional who was a gatekeeper with regards to my access to the young people. 1 tried to persuade hi.that we needed to invite young people who had experienced some of the challenges we expected young. people to be dealing with to become peer counselors. In other words, 1 argued the invitation to become a peer counselor should be broadened beyond those who were seen as model students. The gatekeeper stalled on agreeing to the training workshops or inviting students to participate. When I had given up on the possibility of doing the peer counseling workshops because the trainer was about to leave the island, this gatekeeper presented me with a group of model students to be trained just in the nick of tirne.

1 do not want to denigrate the importance of the peer counselor training in terms of building capacity among youth. The experience was powerfùl for me and the other participants; the courage and enthusiasm of these young people was impressive and gave me hope. There was also the potential for these "model students" to build alliances with more marginalized youth and act as an effective conduit for the experiences and opinions of a variety of young people to reach decision-makers and the Anguiiiian public. However, the process by which students were invited to become peer counselors is an excellent iilustration of the types of students selected to represent youth and the externally irnposed limitations 1 encountered when tryÏng to broaden youth representation. The Youth Consultation on Adolescent Sexuality was a breakthrough with regards to youth participating in the dialogue and the representation of youth views to the Iarger community. 1 organized this forum with a young woman who had attended the UNFPA summit on Adolescent Senial and Reproductive Heaith and Rights in Barbados, with the support of the Anguilla Youth Council and financial inputs fiom Primary Health Care. Thirty adolescents attended the full-day forum completely of their own volition during a school holiday. The fact that the youth responded to an open invitation fiom the Anguilla National Youth Council and chose to attend on their own tirne attests to their genuine interest. The format of the consultation was speakers and presentation of the suwey data, followed by working in small groups to select priority actions for improving adolescents sexual and reproductive health. The youth dramatized the lifie situations of Anguillian adolescents as explanations of the pnonties they had selected and presented them at the closing plenary. During the Youth Consultation, young people examined the underlying causes contributhg to their situation, put forward alternative realities and interpretations, and conceived of possible immediate and long-term solutions. For example, during the Youth Consultation, one of the groups of youth developed a skit about a teenager who goes to a discotheque, has sex, becomes pregnant and is kicked out of her home. In contrast to the narrative of the moral panic, in this story the girl becomes pregnant not because of her failed moraiity but because she has been denied information about sexuality and reproduction. The skit tells an aitemate story about teenage pregnancy in Anguilla, in the idiom of the people who are affected, as an argument for sexual health education. Young people, some of whom 1 knew to be quite shy one-on-one, seemed cornfortable using theatre.49 The ease with which youth slipped into the skits, and adopted the role of the the sexualiy wayward daughter or wrathfùl mother, suggests theatre would have been an appropriate modality for exploring aspects of the Anguillian sexual culture while protecthg the participants from social censure. Techniques from Agosto Boal's Theatre of the Oppressed could have been used to foster participatory analysis of sexuality and youth-driven problem solving while side-stepping fears around self-disclosure and confïdentiality (Boal, 1992). While the survey data provided the foundation for the Youth Consultation, the type of reality or truth generated by the survey pertains more to the critena and interests of international funders, upper bureaucrats and adults than it does to the concerns and interests of young people. My observations at the Youth Consultation indicated theatre could have been an alternative means for generating a discussion. Furthemore, as a "rehearsal for reality", theatre could have provided a

4%e high level of cornfort with drama is logical because many aspcçts of Anguillian culture are performative, for example singing and dancing in church or at the disco. Also. Anguillian interpersonal communication tends to be qui te e'rpressive. powerful mechanism for young people to articulate their experience and simulataneously build rnomentum behind youth originated strategies for bruiguig about change (Boa], 1992, xxi). By employing theatre and sdgroup discussion, the consultation foiiowed the Uisights of Friere (1 970) and Giroux (1994, 1996) regarding the importance of grounding learning experience and knowledge production in the lived realities of the leamers/ research participants. The process of imagining and representing these alternative realities can aUow people to "rehearse identities, stances, and social relations not yet permissible in politics.. .[and also serve] as a concrete social site, a place where social relations are constructeci and enacted as weii as envisioned" (Lipsitz, 1994, 137). Representation can dari@ and strengthen group members' adherence to new values or ideas ~ano,1994, 12 1- 127), and the group dynamic can support new norms: "Groups rapidly develop subcultures with norms and values that enhance learning of new concepts and skills. Positive social interaction enables both cognitive lehgand behavior change to occur more rapidly and in different ways than in one-on-one encounters or counselhg" (Baileys and Buhra, 1995, 25 1). Finally, public representation or rehearsal of dtemate realities provides an opportunity to build alliances as well as communicate with the iarger public and decision-makers. In contrast to the construction of young people as "morally compt" or "a problern," media reports cast young people as problem solvers by reporting on their priorities and proposed actions. me Anguziiian reported that young people had prioritized enforcement of laws on the age of sexual consent for both sexes and the need to ensure support for pregnant girls and teenage parents to continue their education, including provision of day care. The article also gave a full account of the strategies young people proposed for reac hing t hese objectives (Piwcolo, 1999b). Furthemore, coverage of the Youth Consultation disputed the primacy of top-down communication and decision-making between adults and youth or service providers and service recipients by supporting the principle "that young people are an imponant resource and should be full and responsible partners at al1 tevels of planning and decision making" ("National one day", 1999). The media's description of youth as active and legitimate participants in addressing adolescent sexud and reproductive health could be buttressed by adults' hstration with some of the survey fhdings and provoke adults to think about research methodology and communicating with young people in a new way. The descriptive nature of the survey meant that explanations for why young people selected their responses were not available:

They wanted cclll.2informution: Why did the kids become sexuah'y active? Whar were the psychoiogrgrcaIprofiles of kids who were sexuufljactive? U%y dh't they ~~slteachers? etc. I told them thor I agreed it wasfiustrating but that ~his of research rnethodoIogy cm? merthose questions. I suggesed focus g~grarpsrmd open-ended questions are more e#ec fivefor gening ut those issues. veldNotes, Mmch 26, 1999) The hstration of adults, in this case teachers who are authority figures for adolescents, with the failure of the survey to answer the "why" questions could push them towards dialogue with adolescents because they realized the limitation of one-way, top-down communication. The role described for young people and the respect accorded to the strategies developed by young people in the media wverage of the Youth Consultation was a clear deparîure fiom the representation of young people as moraliy deviant and sexually irresponsible that characterized the moral panic. It seems reasonable to assert the dissemination of information about the youth consultation would engender a feeling of accomplishment among the youth participants and contribute to shifhg the discourse about youth in the Anguiliian public sphere. Moreover, the dialogue among youth, among youth and adults, and among adults about adolescent sexual and reproductive heaith in the context of the community consultations may have engendered a pater capacity for youth to speak, and adults to listen to youth, with regards to this topic.

Criteria Three: Talk and Action It cm be asserted that the presentation of the survey data in community consultations and the media coverage of these meetings increased capacity among the stakeholders to dialogue about this issue and produced discourse that tended to contest the logic of the mord panic about youth sexuality. However, what was the relationship between this talk and the implementation of the recommendations that I and the other stakeholders made? To understand the generai lassitude with regards to irnplementation once 1 lefl Anguilla, it is necessary to re-examine the social relations that contributed to the aiiies 1 chose and the primary research rnethodology 1 employed and their consequences for various Anguillian group's expression of political will with regards to acting to improve adolescent semal and reproductive health. The closing plenary of the Youth Consultation was designed as an opportunity for "educators, members of government, health professionals and the media to hear the views and resolutions for action of AnguiUa's youth" ("National one day", 1999). Notably absent ffom the closinç plenary were the top two decision makers in the public health field, who had been my primary supe~sorsduring my time on the island. They were not the only decision-makers who did not aîtend; oniy four of the eight invited individuals from upper management appeared at the closing plenary. However, the absence of the decision makers who were my supenisors, even if innocent or unavoidable,50 is an excellent indicator of the difficulties 1experienced in moving towards implementation, dficulties that arose fiom my positionhg in the local context. My fint contact in Anguilla was with upper managers, and 1 was introduced to and by thern as a "foreign expert." My acceptance of upper managers as my primary ailies, and consequent adoption of a survey methodology, meant that in many respects, the projet reproduced the top-down power relations that characterized heaith care as weii as the rest of the AnguiIlian social structures that 1 observed. My investment in upper managers as the primary change agents with respect to adolescent sexual and reproductive heaith, instead of youth themselves, retarded implementation of the recornrnendations that 1 and other stakeholders made. My officia1 contact person on arriva1 in Anguilla was the Permanent Secretary of Social Services, who exercises effective power over the spheres of education, primary and secondary health care, and community development and welfare. The Permanent Secretary and the men who headed primary and secondary health care remained my primary contacts and were perceived by me as my strongest supporters until we began to discuss the response to the research findings. In my mind, upper management provided the iegitimacy, contacts and clout that aiiowed me to work

50~othmen had made a verbal cornmittment to me to attend the meeting, and when asked why bey had not attended, one cited an unforeseen personal difXcultyand the other another meeting as reasons for their absence. in the highiy sensitive and potitically charged field of sexual and reproductive health; 1 thought that in order to attain the outwmes or "action" 1 wanted, their support was necessary. The

potential failure of my alliance to produce the results 1 desired was foreshadowed in an early moment of clarity about the politics of my positioning. 1 wote:

I feel as ifpart of the idea behind the sttrvey is that it will keep me out of the way, mak me feel l am doing something usefil (mtd it will be usefirl in rems of kawing a picture of addescent health) but won't leave enough time to rock the boat. (Seplember 22, 1998' My desire for change or action, and the associated subject position and alliances 1 took up, infiuenced my methodological decisions. These choices created a dynamic of support and containment between myselfand my supe~sors.In the end, the support did aiiow the research to be completed but effectively contained the action that could have corne from the research. My designation as a researcher working outside the regular programs of the health care system and reporting directly to upper management probably influenceci my relationships with people in middle management and working on the front iines. The top-down hierarchy is overlaid and reinforced by gender and educational stratification. The top of the hierarchy, who make decisions and Liaise with foreigners and international institutions, are well-educated men; the people who actuaiiy provide most of the services are women, who in many cases have received only rudimentary fonnal education; the seMce recipients are relatively marginalized as demonstrated by the fact they are accessing the public health system iristead of the preferred private system. The iikelihood of beneficiaries taking an active role in shaping the services they

receive is even more limitai when they are children or young adults without even the social status associated with the age of majority. The "top-dom, authoritarian (doctor knows best)" attitude may be a particularly strong feature in the professionai culture of the health field (Eyben and

Ladbury, 1995, 194-196). Studies of the health care system in Anguilla have noted patients perceive doctors and nurses to be quite authoritarian (Carter-Davis, 1997, 78; Kidd, 1997; Interview with facilitator for an island-wide comrnunity consultation on primary health care, August 12, 1998). As a seMce recipient, 1 experienced the top-down authoritarianism of the Anguillian health system; upon volunteering a self-diagnosis of my symptoms as strep throat and suggesting a throat swab, the male doctor tumed to me and said: "1 am not a waitress." In contrat, in my role as a foreign researcher associated with the highest levels of the local health care hierarchy, 1 was accorded privileges. The most relevant example of that privilege was the decision of upper managers to fûnd my Adolescent Sexual and Reproductive Health Swey rather than respecthg the preference of some of the rniddle managers by administering the Pan Arnerican Health Organization fùnded Caribbean Youth Health Survey? The research process 1 employed was a result of and replicated the top-down logic prevalent in the Anguillian health care system. In retrospect, the divergence between my expected optimal outcornes for the project and those of the people to whom 1 was reporting were clear in the decision-making process about the research methods 1 would employ. From the tirne of my first introduction as a consultant working with Primaiy Health Care to the presentation of the survey results, 1 took every face-to-face meeting and media inte~ewas a chance to present my expertise and the research 1 was dohg as tools to be used by the community. On the other hand, my supervisors perceived a participatory or community development mode1 to be irrelevant. For exarnple, 1 felt it was important to consult everyone who had participated in the needs assessment about the results. My supervisor felt consulting the heads of departments rather than heads of departments and fiont-line workers would be sufficient (Field Notes, September 22, 1998). In this instance 1 persisted. With regards to methodology 1 was not as firm; the tension between my ideals and those of my supervisors are evident in the notes 1 wrote der a joint interview to inform the community that a survey on adolescent sexual and reproductive health was going to be adrninistered in the secondary school:

l~urin~the development of the Adolescent Se.& and Reproductive Healîh Survey, 1 was not awmhds were avdablc fiom PAHO to conduct the Caribbean Youth Health Survey nor that members of the rniddle management of prirnary heaith care prefened to participate in the PAHO survey. 1 would have happily assistecl with or managed the administration of the Caribbean Youîh Heaith Survey, but this was not presented to me as an option. I was laiking about information [we worrfdgalherfi.omthe survey] as a buisfor communiiy àiaiogueeJohn imariabiy gws quiet when I begh fo taik about community comlfationrmdparlicipafory methodofogies [...]He wdhave gone forwmd with the survey afrer receiving pis nrperiork] approvaf.But he praises me, saying my methodoiogy is gdtelhg others to upprove. (Field noies October 28, 1998) The primary strength of the research, according to my supe~sorwas "my methodology," which he chose. My comment about the importance of his praise and role in telling others to approve reveals that 1 perceived his support to be personaily important and necessary to the success of the project; in other words a necessary trade-off of a more participatory process for the institutional support 1 thought would result in actions to improve adolescent sexuai and reproductive health. Looking back, 1 perceive the centrality of the survey methodology to the project and related expectation that upper managers would act to improve the senial and reproductive health of adolescents to be a tactical error. Through this mistake, 1 have gained valuable insight into the relationship between means and ends. The alliance 1 made with upper managers and the subsequent selection of the survey methodology played an important role in determinhg the social relationships produced by the project. Friere writes:

.. . to substitute monologue, slogans, and communiqués for dialogue is to attempt to liberate the oppressed with the instruments of domestication. Attempting to liberate the oppressed without their reflective participation in the act of liberation is to treat them as objects which must be saved from a burning building [...] They [the oppressed] cannot enter into the struggle as objects in order ber to become human beings. (Friere, 1970,47-50) Establishing my prïmary relationship with upper managers rather than young people and selecthg a survey methodoIogy, which positioned young people as "objects" who answered questions, rather than subjects who determined which questions should be asked, affêcted the process that took place when the research was completed. Upper managers made it possible to conduct the research, but response to the research or support for the recommendations (for some, not even insofar as reading the findings) did not materialize. The political and technical rasons for stailing were illustrated when 1 met to discuss the research findings with the three men who were materidy responsible for running Anguillats health service: The four of us [upper managers and myseiff iaugh about making copiesfor the Executive Councif. The qparent joke is that they [rhe Erecutive Council] won't read it, but neither have the men laughing read the document in detail. (Field Notes, Jmary 6, 1999). WMe the men responsible for primary and secondary health care eventuaiiy read the report in detail, 1 am ahost sure the members of the Executive Council did not. Just prior to Ieaving Anguilla, my irnmediate supervisor manged a meeting with the Minister of Social Services. My misunderstanding about the purpose for the meeting is a clear illustration of my naiveté and the problem of making my primary alliance with upper management.

Yester&y was a slip in the face &yfor me. 1met with John and Minister Baird in the morning. mere was reaffy nothing to say because the Minisîer had neirher read the darumen& I've prepmed or been briefed He [rhe Minister] told me how thanyirl the AnguiIlian govemmeni is to [the tlon-govemmental organization who sent meJ 1asked him point bhtk if ite had read the report. He said no, and I told him as tac@& as possible he shmddfi~ldthe tirne because it wifi provide motivation tu look at and deal with the issues. @eid Notes, Mmch 25, 1999) The meeting, which I had interpreted as an opportunity to discuss the options the Ministry of Social SeMces was considering in response to the research findings, was seen by the Minister purely as a social obligation to thank me for rny work on the idand. In my hstration, 1 transgressed the social role dictated by my position as a younger, less powerfûl woman and implicitly criticized him for not reading the report. My employers were not pfeased by this transgression, making it clear that acting "according to type" as a polite, young woman had been an important element in building my relationship with upper management. The failure of important men in the Ministry of Social Services to read the findings of the Adolescent Reproductive Health Survey was related both to the channel of cornrnunication and political will. A thirty-page report, even when accompanied by a ten-page summary, is not an effective information dissemination tool in the AnguiHian context. With the exception of the Minister of Social Services, 1 did not ask individuals if they had read the report, but it is still telling that fiom thirty reports and executive summaries which 1 distributed, 1 oniy received positive confirmation the material had been read from four individuals. To some extent, 1 was successful in overcoming this barrier by making public presentations and eventually pubticking the findings in the mass media. However, the primary barrier to implementation was not the means of communication but a lack of poiiticai di. Upper managers had little to gain, and much to lose, by publicly championhg the recommendations 1 made. In fact, it is important to stress that in some respects the lack of attention given to the survey data by upper managers is an expression of good intention rather than malice. In the climate of mord panic, any of these individuals could have gained political ground by using the survey data to Merdemonize adolescents as sexually active and morally compt. With the exception of grandstanding in the tradition of the moral entrepreneurs,

discussing adolescent sexual and reproductive health could oniy be expected to bring political

The consequence of this situation was that despite the establishment of prïorities and strategies during the community consultations (Field Notes, January 6, 1999; Field Notes, Februaiy 4, 1999; Field Notes, Febniary 12), actions which were removed Eom my responsibiiity

and delegated to upper management did not o~cur?~An example of this was the strategy

deterrnined for involving the churches in the dissemination process. It was evident to me that the

churches were essential to addressing adolescent sexual and reproductive health in Anguilla, and 1 hoped they could be used as a resource but I was dso womed about the possible reaction of church leaders. In the community consultation, members of middle management who identifieci themselves as Christians, argued strongly against sharing the data openly with religious leaders? These middle managers felt religious leaders would use the data to "talk helifire and danmation"

52~pperand middle mamgers in the social senices saorreached consensus abwt eaending sexual health education into the primary school and discussed strategies for implementation of the curriculum (Field Notes, January 6, 1999; Field Notes, February 4, 1999; FieId Notes, Fcbruary 12; The Daily Herafd, Febniary 27, 1999). They also discussed the political ramifications of releasing the survey data and developed a strategy for doing so. One of the reasons upper management decided to circulate a surnrnary of the weyhdings to the Executive Council before permitting theu release to other stakehoiders and the media was because of fears around how the statistics could be interpreted and used politically (Field Notes, January 6, 1999). In a mixed meeting of upper and middle management as weil as fiont line workers, one of the bureaucrats stated "if'this agenda was to be moved fonvard, it wouid be us, the technicians, who will have to movc it forward, not the politicians" (Field Notes, February 5, 1999). 1 took tbis as an encouraging sign of AnguiIlians starting to own and take responsiiility for the process, as well as a pragmatic response to the political volatility of the issue of adoiescent sexuality. Ta my great disapointment, the actions coiiectively agreed upon have not iaken place. 53111Anguilla, capital C "Christian" means that you actuaily live acoorduig to your church's interpretation of the Bible and not simply that you believe in Christianity and attend church. 129

(Field Notes, February 5, 1999). Sensitized to the moral panic, I agreed it was irnperative not to provide information in such a way that it could be used to reinforce the characterization of young

people as moraliy compt. Participants felt the church youth groups would be an excellent venue to discuss the survey results and begin some form of sexual health education. Based on my experience workùig with young people who beionged to these youth groups, and aware of the importance of the youth groups to young people, and the importance of young people to the churches, 1 agreed with this strategy. However, in order to access the youth groups, it was seen as necessary to meet wîth the church leaders. It was discussed that 1 would not be the most effective messager to bring the information to the religious leaders. 1 heartiiy agreed. The strategy elaborated was to approach the ieaders of the more moderate churches (the Christian Council) and enlist their support before proceeding to engage with the more fùndamentalist organizations

(the Evangelical Brotherhood) (Field Notes, Febniary 5, 1999). However, in the seven months after my departure, these meetings with religious leaders did not occur. In retrospect, it seems it would have been more effective for me to bypass the upper managers and the church leaders by providing the information directly to youth church groups represented in the Anguilla National Youth Council. In some respects, this analysis points to the absurdity of asking the powerfùi for permission or support for changes designed to benefit the disenfranchised. One of the issues 1 have struggied with is the idea that failure to rapidly implement the recornmendations I made based on the survey data signified the community was not ready to approach the issue of adolescent sexuality. 1 asked rnyself repeatedly: "if Anguillians dont want to deal with the issue of

adolescent sexuality, who am I to intervene?" On the other hand, the data 1 gathered about the sema1 practices of adolescents in Anguilla and knowledge of how HIV/AIDS was affecthg other young people in the Caribbean, who had sirnilar practices, created a situation in which 1felt tom. 1 feared great suffering and loss of Me would result fiom inaction. Subsequently, 1 recogiized that the idea "the community" was not ready to address issues of adolescent sexuality was based on assurning a false homogeneity of interest. Despite the shared ideal of sexual abstinence for adolescents, a key dflerentiation within the Anguillian cornmunity was between adults and adolescents. This difTerence was revealed by reactions regarding the percentage of teenagers who reported having had sex. Operating within the logic of the moral panic, adults had identified adolescent sexual activity as a cnsis in Anguilla. Yet, many adults reacted with incredulity to the percentage of young people who reported being sexualiy active. Resistance to the survey findings was expressed by questioning the wiliingness of students to answer honestly, the ability of the students to understand the survey questions or the representativeness of the sample. Comments like "the numbers would be different if ail of the respondents were Christian" or "lots of immigrants have come to the island so maybe the children became sexually active before arriving in Anguilla" were made (Field Notes, March 26, 1999). In contrast with the resistance to the survey findings expressed by adults, youth stated that based on how adults talk about adolescents and sa, they found the forty percent figure low. One young woman said: "The way they [adults] talk about teenagers and sex, you would think everyone wirs doing it" (Field Notes, February 18, 1999). Adults criticized young people for their sexual activity, but when clahabout the prevalence of teenage sex were validated, they moved to deny that the issue existed within "their" cornmunity, i.e., Christian or Anguillian. In contrast, youth accepted the prevalence of sexual activity and pointed out that the majonty of Anguillian adolescents did not report having had sex?

The differential wiilingness of adults and yout h to confront and grapple with the realities of Anguilla's semial culture translated into a differential willingness to take action. An illustration of the variable wïüingness of adults and youth to take constructive action were reactions to the

54 In response to addt skepticism about the validity of the weyfindings, I described the seps taken to ennire the anonymity of the survey respondents and stated ihat 1 believcd we had done everyîhmg possible to encourage people to be as honesî as possiile in answering the survey. In every session addts asked me if the young people understood what "having sex" meant. 1 explained ihat young people had picked the phrasing of ihat question to read "have you ever had sex" and told me young peoplc uscd it that way and would understand sex meant se.d intercourse. It was extremely important for justifjing the results that young people had participated in developing the survcy questions and had assured me that the language used was appropriate for their age group. In response to questions about how 1 could be sure the results werc accurate, 1 e-xplained that given the random samphg and the number of surveys completed for the size of the population, the survey offered a ninety-nine percent confidence level. Ln terms of arguing the need for reproductive and sesuai health education and services in the public system, because the challenges were a&cting aU Anguillian youth. it was important to be able to explain the random sample and that, in hct, statistical probablities suggested the pictwe presented by the meydata did apply to the youth of Anguilla. This was the political advantage of the quantitiative survey methodology. proposed distribution of an educational pamphlet that contained explicit written and visual directions for using a condom by an upper manager and a yo~th.~~1 collaborated with both of these individuals during the eight months 1 spent on the island. Both of them are committed Christians, advocate abstinence as the best option for adolescents, and care about the health of Anguillian teenagers. The adult recognized the pamphlets as an exceIlent resource but refùsed to allow their distribution until more "sensitizing" education was completed. The youth reacted to the refùsal to distribute the pamphlets with angry disbelief, stating: " but kids are having sex"

(FieId Notes, February 5, 1999). Youths had more to gain and great deal less to lose than upper managers when it came to taking action on adolescent reproductive and sexual health.

Consequently, 1 should have invested more energy into working directly with young people. 1 allied with upper management and made compromises to build and protect this alliance because 1 felt their support was necessary to bring about change. This choice illustrates the dangers of thinking in terms of scarcity or need which must be met extemdy before change can occur. In some respects, upper managers were operating under the sarne logic. When severd front-line workers comrnented: "the report did not tell them anything they weren't already aware of or make any radicaily new suggestions; [an upper manager] stressed the importance of "scientific, quantitative" data in order to obtain support from fünding agencies" (FieId Notes, February 5, 1999). The dure of power and desire to attract outside resources support choices which eventually lead us to "represent the world as it is for those who rule it, rather than as it is for those who are ruled" (Smith cited in Escobar, 1995, 107-108). In my case, the compromise to gain institutional support did not have a happy result. The irrelevance of resources without political will to deploy them difFerentiy was demonstrated to me when, near the end of my eight-month stint, 1 discovered a thin technical report fiom the United

pamphlets were excellent because they used very simple language, includiog cornmon street language, and al1 of the instructions were accornpanied by explicit visual illustrations. As a consequence of my research, 1 have reviewed countless HIV/ALDS prevention pamphlets creatcd for use in Canada, the United States, Mexico and the English-speaking Caribbean. Whiie most pamphlets do a reasonable job of explaining transmission through body fluids in simple language [blood, semen, mother to child not through casuai contact], very few effectively define the kinds of sexual activities which involve sharing body fluids or communicate how to use a condom. The pamphiets 1 had ho@ to distriaute, fiom the BC People With Disabiliues Network, were clear enough that a young person or a person with limited literacy could actuafly learn that peopIe contract HfVhou@ specinc se.Yual activities and leani to eff'vely use a condom from the pamphlet. Nations Family Planning Association tucked away between two thicker volumes in the readiig room of the public library. Written in 1984, the document surnmarized the short-tenn objectives of a project begun in 1979: developing "more responsible" attitudes towards sexuality and contraception among youth, improving the sexual and reproductive knowledge levels of youth through in and out of school education, and providing "recreational and health râcilities for youth [including semial and reproductive health services] in the form of a multi-fùnctional youth community center" (üNFP4 1984, 54). The first point in the Regional Action Plan adopted at the United Nations FdyPlanning Association Caribbean Youth Summit on Reproductive Health and Rights held in October of 1998 was "the establishment and fùrther development of youth centers which offer comprehensive programs on reproductive health care and other social

services by 2001" (UNFPA, 1998b, 1 1). The thrust of the recornmendations 1 made in "Key Findings and Recommendations of the National Adolescent Reproductive Health Survey" centered around establishing a multi-use youth health chic that wouid provide a range of health services and educational opportunities (Kendaü, 1998a). Despite the same recommendation being made over a period of meen years, and considerable outside resources being offered and consumed, the youth health center has not been implemented. Early in the research process, 1 expressed skepticism with regards to Anguiliians' explanations for why the health system could not change:

1feel an inertia in Anguilla. Nothing cari ever get done: "because the island is tm mail; we don't have the money; we dodt have the properiy trainedpeople; we don'f have the rime; everybody knows everybody, etc. " 1 don't believe it. (Field Notes, Ocfober 10, 1998). My idea was that the needs assessment, research and consultation process could ident* available resources pertinent to the sexual and reproductive health of adolescents. Through the research and community consultation process, 1 discovered that the UNFPA had constructeci the building that was used as office space by the health education unit and the school nurse to fùnction as a youth health center. In addition, UNFPA and PAHO had paid for travel, training and salary top- ups for several family life educators, most of whom were working as regular teachers in the school system when 1 was in Anguilla (UNITA, 1984; Field Notes, February 5, 1999). Consequently, 1 wrote recommendations based on the reallocation of existing local resources. In the foliowing eleven months there has been Little movement towards implementation, demonstrating that it is not resources per se, which are the issue, but motivation and intention among the appropnate groups of people. This is not to argue that materiai resources or cultural capital are irrelevant. Nor is it to argue that outsiders such as myselfhave no role or responsibility in trying to open spaces in which the people concemed can discuss their situation and how they wish to proceed, as occmed during the Youth Consultation. In fact, 1 was told by several youth that my presence was crucial for putting pressure on aduits in the social seMces institutions that helped the Youth Consultation to occur and facilitated the emergence of the Junior AIDS Cornmittee and the peer counseling program (Field Notes December 6, February 16, February 2 1). Over the course of the project, 1 came to the conclusion that opening such spaces is the most useful work that can be achieved:

We [resemchers] cm be the risk takers- ,lot the charisnmtic leaders- but people who stick our neckr out- on behalfof a need andperhops get mr heah chopped 08 Pub licizing "a need" rnay have a catalyic eflect. nevolunteer/ international developmenf worker may then be seen ar a catafyst. My other thoughts about this is that the most important thing is not fofinish "aprOaUct" to get the projecf done, but fo ~onsformpeople. This Ïs the most meaninfil work. Jaai'i [a Cdianvolunteer] cmselirlg skiiis workshop was exciting in this regard- nor realiy because it improved the Ievel of counseling skiifs or the avaiiability of coumeIing immediatefy but because it gives people an opportunity to change themselves, to open in ways they never believed possible. And these micro sh#s are what will ulrimatefy charge a comrnurrity " (Field Notes, Decernber 31, 1998). In the quote above, 1 use language " to transfonn people" which is the language of the subject who modifies the object of research or development. A few sentences later, 1 write about a space which "gives people an opportunity to change themselves." These very different views of change and subject positions which are invoked by language choices are an excellent metaphor for the tension between what I wanted to do in Anguilla and where 1 wanted to be positioned, and much of the work 1 actuaily undertook. From the outset, 1 positioned myself as working in the interest of the sexual and reproductive health of adolescents, but the bulk of my work could be characterized as for adolescents rather than with t hem. 134

CONCLUSION I cannot say that given another opportunity and knowing what 1 know now, 1 would not use a survey to conduct research on adolescent sexual and reproductive health in Anguilla. As 1 have argued, the information gathered through the survey provided a foundation to present an argument about adolescent sexuality that contradicted the dominant logics of the moral panic. Furthermore, the presentation of the survey data provided a safe space for discussion that did not mark the subjects or their social networks as deviant and fostered dialogue about the gaps between the semai ideas and sexual realities operating in Anguilla. Priorities and strategïes were considered by the people who were directly affected and those who were implicated in education and service provision. Furthermore, fiom al1 available evidence, the discussion occurred without provoking further moral panic. The representation of the data and the youth in the mass media moved away fiom blaming youth as moraily corrupt and towards supporting an active partnership between youth and adults to address issues of adolescent semai and reproductive health. The consultations also contributed to increased capacity on the part of adults and youth to begin this process. Thus, the survey provided an opportunity for what 1 consider to be an important process to take place. The recommendations 1 proposed have not been implemented, however this does not mean the project was a failure. 1 can only hope, as I was told by the director of a local non- govemmental organization, ttYoll are making an impact. Yow presence is beirig fell eveir ifyuu are nof meof it. / hem about you even wherl I dodf see you" me/d Notes, November 4, 1998). The long-term effects of the project are neither knowable to me nor ultimately under my control.

Despite positive outcornes from the research and dissemination process, in hindsight 1 would allocate my energies dflerently, particularly with respect to whom 1 chose to build relationships with and the methods employed for this relationship building. When 1 arrived in Anguilla, 1 perceived young people as victimized by the discrepancy between the moralistic, scripturally based sexual culture propounded by adults and the dominant sexual practices in their society. in my view, Lot's righteousness created a social context that contributed to unde sexual decision making by his chiîdren. 1 spent much of my energy speaking to Lot, in an effort to convince him to change his ways and take steps to improve his children's situation. 1 conceived of Lot as the person with the ability to protect his daughters, forgetting that he was willing to sacrifice them to demonstrate his righteousness. Paying greater heed to the story of Lot and his daughters after they lave Sodom and Gomorrah might have altered my view of the youth as victimized and positioned young people over upper managers as the most prornising allies:

He bot] and his two daughters lived in a cave. One day the older daughter said to the younger, "Our father is old, and there is no man around here to lie with us, as is the custom ali over the earth. Let's get our father to drink wine and then lie with hirn and preseme our family line through Our father. " [.. .] So both of Lot's daughters becarne pregnant by their father. The older daughter had a son, and she named hirn Moab, he is the father of the Moabites of today. The younger daugher also had a son, and she named hi.Ben-Ammi; he is the father of the Ammonites of today (Genesis, 19). Driven fiom their city by the punishing anger of Yahweh, separated fiom their promised husbands, who remained to burn in Sodom and Gomorrah, left with only one parent because their mother's disobedience resulted in her transformation into a pillar of salt, and living in an isolated cave, Lot's daughters seem to be without resources or options for action. Yet, with a clearly defined objective and through their own ingenuity, Lot's daughters give birth to two tribes of people. The story of Lot's daughters is a reminder of the power of apparently disenfianchiseci people to achieve their goals.

1 recognize the deception of Lot and incestuous relationship through which Lot's

daughters achieve their goal are controversial, particularly in the context of a discussion of sexual culture. Ifincest is the ody apparent option, the social forces that fiame this choice must be explicitly examined. As incest is not the means I would support, my role as an outsider might be to invite Lot's daughters to examine the socialization which has made having children such an important goal or to suggest other means of reaching that goal by showing them the mouth of the cave or teiling them of men in other villages across the desert. The new ixforrnation and space for reflection is offered not to determine what Lot's daughters will do but to support them in identifjmg and reaching objectives that benefit them. This process will likely engender cultural change. Howard writes: "The key concem is how to preserve a space for the relatively autonomous transformation of traditional cultures in such a way as to Ieave their core self- defining values intact. Traditions are social constructions. They must remain actively

constmctionist and dynamic or they will die" (Howard, 1994, 202). In my case, the goal became to support spaces for young people to cntically and creatively examine the social relations that stmctured their sexual and reproductive lives, with the goal of birthing "traditions" or norms that better met young pwples' own objectives. This dynamic began to emerge near the end of the project through my work with groups of young people involved in the Youth Consultation, the Junior AIDS Cornmittee, and the peer counseling training. Had 1 spent less time and resources engaging with upper managers and more with the youth themselves, these activities would have begun earlier, and 1 wodd have been able to offer them more time and support. Thus, the lesson 1 learned, and the recomrnendation 1 would make to $%ber researchers who are interested in supporting the well-being of people who are not siîuated at the top of social hierarchies, is that better results can be achieved by positioning oneseifless as Lot's guest, and more as Lot's daughters' fiiend. Works Cited

Adolescent health survey throws up alarming figures. (1999, February 27). The Dailv Herald, p.7.

Aian Guttmacher Institute. (1994). Sex and America's Teenagers. New York: Author.

Men, C. (1997). Women, Health, and Development: The Commonwealth Caribbean. In Springfield (Ed.), Dau-gthers of Caliban. Caribbean Women in the Twenûeth Century @p. 171- 2 12). Bloomington, Indianapolis: Indiana University Press.

Alvares, C. (1992). Science. In Sachs (Ed.), The Development Dictionary (pp. 219-232). London: Zed.

Amaro, H. (1995). Love, sex, and power: Considering women's realities in HIV prevention. American Pmcho1oaist.50,437-447.

Anguilla Democratic Party. (1999). Sta~On Tirne: Aneuilla Democractic Party Manifesto. Anguilla: Author.

Aral, S. and Wasserheit J. (1995) Interactions among W,ûther Sexually Transmitted Diseases, Socioeconomic Status, and Poverty in Women. In OZeary and Jemmot (Eds.), Women At Risk: Issues in the Primaq Prevention of AiDS (pp. 1341). New York: Plenum Press.

kved, B. and Lobdefi G. (1984). Parent-child communication about sexuality: The physician as comrnunity educator. Journal of Adolescent Health Care. 5,292-293.

Banks, V. (1992). Twenty-Five Years Later: Time to Repup. Twenty-fifih Anniversarv of the An-aillian Revolution 1967- 1992. Anguilla: Govenunent of Anguilla.

Norman, B. and Moore, S. (1 990). Adolescents Attitudes and Precautions and Intention to Use Condoms. Psvcholo~calReports, 67,883-890.

Baylies, C. and Bujra J. (1995). Discourses of Power and Empowerment in the Fight Against HIV/AIDS in Aûica. In Aggleton et al. (Eds.), ADS:Safetv. Sexuality and Risk (pp. 194-222). Bristol, PA: Taylor & Francis.

Bledsoe, C. (1994). Construding Natural Fertility: The Use of Western Contraceptive Technologies in Rural Gambia. Po ulation and Develo~mentReview, 20,s I - 106.

Blum, RW. et ai. (1998). Caribbean Adolescent Health Survev: Antirna Dominica, Grenada Jarnaica. The Pan Amencan Health Organization, Caribbean Sub Region, Barbados, W.I. and the WHO Collaborating Centre on Adolescent Health, Division of General Pediatrics & Adolescent Health, University of Minnesota, Minneapolis: 1998.

Boal, Agosto. (1992). Garnes For Actors and Non-Actors. (Trans. A. Jackson). London: Routledge. (Originai work published in 1992). Brandt, A- (1985). No Maeic Bullet: A Social History of Venereal Disease in the United States since 1880. New York: Oxford University Press.

British Columbia Ministry of Health and Ministry Responsible for Seniors. (1 994). Hdthy Communities: The Process. Victoria, British Columbia: Author.

Canadian International Develoment Agency . ( 1998). Policies-Priorities. (www.acdi- cida.gc.ca~cida~ïnd.ns~

Carael, M. and Piot, P. HIV Infection in Developing Corntries. (1989). Journal of Biosocial Science.2 1-35-50.

CAREC. (1989). Epidemiological notes and reports. West Indian Medical Joumal.38, 187-189.

CAREC/ Anguilla Ministry of Health. (1 991). Report of National Survev of Knowledtze, Attitudes. Beliefs and Practices Reearding AIDS in Anmilla. Anguilla: Health and Family Life Education Centre.

Carter-Davis, S. (1997). Anmillian Nationals Seek Health Care Out of the Island: An Analvsis of Causes and Conseauences. Unpublished Masters thesis, South Bank University, UK.

Carty, B. and Petty C. (1997). Anguilla: Tranquil Isle of the Caribbean. London: MacMillan Education Company.

Cashmore, E. (1997). The Black Culture Industry. Routledge: London.

Cates, W. Teenagers and sexual risk taking: the best of times and the worst of ümes. Journal of Adolescent Health, 1 2,84-94.

Chasnoff, S. (1996). Performing Teen Motherhood on Video: Autoethnography as Counterdiscourse. In Smith and Watson (Eds.), Gettine a Life: Everydav Uses of Autobioera~hy (pp. 1 08-13 3). Minneapolis: University of Minneapolis Press.

Christian-Smith, L. (1994).Young Women and Their Dream Lovers: Sexuality in Adolescent Fiction. Ln J. Irvine (Ed.), Sexual Cultures: Adolescents. Cornrnunities and the Construction of Identitv @p. 206-227). Philadelphia: Temple University Press.

Clatts, M. Disembodied Acts: On the Perverse Use of Sexual Categories in the Study of Hi&-Risk Behaviour. (1995). In Brummelhuis and Herdt (Eds.), Culture and Sexual Risk: Anthropological Perspectives on AIDS (pp. 241-255). Amsterdam: Gordon and Breach Publishers.

Cleland, J. and Ferry B. (1995). Sexual Behaviour and AIDS in the Developine World. London: Taylor & Francis. Che, R and McKenzie N. HIV/AIDS, Women, and Threads of Discrimination: A Tapestry of Disenfianchisement In Ray (Ed.), Communication and Disenfianchisement: Social Health Issues and Implications (pp. 365-386). Mahwah, NJ: Lawrence Erlbaum and Associates.

Cohen, S. (1972). Folk Devils and Moral Panics. London: MacGibbon and Key.

Coma, S. (1994). Po~ulationand Reproductive Riehts. Feminist Perspectives From The South. London: Zed.

Cox, C. (1997). Medical Education, Women's Status, and Medical Issues' Effect on Women's Health in the Caribbean. Health Care Women International, 18,383-393.

Crago, H. et al. (1996). Myth and Reality in Rural Counselling: Towards a New Mode1 for Training RuralRemote Area Helping Professionals. Australian and New Zealand Journal of Farniiv Theraov. 17,6 1-74.

Diamond, 1. (1994). Fertile Ground: Women, Earth and the Limits of Control. Boston: Beacon Press.

Doyal, L. (1995). What Makes Women Sick?: Gender and the Political Economv of Healt h. Malaysia: MacMillan Press.

Econornic Commission for Latin America and the Caribbean. (1997). Social Panorama of Latin America. Santiago, Chile: Author.

Edwards-Gumbs, A (1997). Communitv Involvement and Comprehensive Schooling in Anaiilla. Unpublished Masters thesis, University of Bristol, Bristol.

Emke, 1. (1991). Speaking of AIDS in Canada: The Texts and Contexts of Official, Counter Cultural and Mass Media Discourse Surroundin~rAIDS. Unpublished Ph-D. dissertation, Carleton University, Ottawa.

Escobar, A. (1995). Encounterins Development: The Makine and Unmaking of the Third World. Princeton, N.J. : Princeton University Press.

Eyben, R and Ladbury S. (1995). Popular particpation in aid-assisted projects: why more in theory than in practice? In Nelson and Wright (Eds.), Power and Particioatory Development: Theorv and Practice (pp. 192-200). London: Intermediate Technology Publications.

Fahie, F. (1 992). In Smch of a Better Life: Anguilla 1967- 1992. Twentv-fifih Anniversarv of the Anguillian Revolution. 1967- 1992. Anguilla: Governrnent of Anguilla.

Farmer, P. (1996). Women, Poverty and AIDS. In Farmer et al. (Eds.), Women Poverty and AIDS: Sex, Druns and Structural Violence (pp.3-38). Monroe, Maine: Common Courage Press.

Ferguson, J. (1994). The Anti-Politics Machine: "Development" and Bureaucratie Power in Lesotho. The Ecoloaist.24, 176-18 1. Fine, M. (1985). Sexuality, Schooling, and Adolescent Females: The Missing Discourse of Desire. Harvard Educational Review.58,29-53.

Forman, M. (1994). "Movin' Closer to an Independent Funk": Black Feminist Theory, Standpoint, and Women in Rap. Women's Studies.23,3 5-55.

Foucault, M. (1979). Discipiine and Punish. The Birth of the Prison ( A Sheridan, Trans.). New York: Vintage Books. (Original work published in 1975).

------. (1978). The History of Sexualitv. Volume One. (R Hurley, Tram.). New York: Vmtage Books. (Original work published in 1976).

Fraser, G. (1995). Modem Bodies, Modem Minds: Mdwifery and Reproductive Change in an Afiican American Cornmunity. In Ginsburg and Rapp (Eds.), ConceiWia the New World Order: The Global Politics of Re~roduction(pp.42-58). Los Angeles: University of California Press.

Fraser, N. (1989). Unrulv Practices: Power. Discourse. and Gender in Contemporary Social Theow. Minneapolis: University of Minnesota Press.

Freudenberg, N. (1995). Strengthening Individual and Community Capacity to Prevent Disease and Promote Health: In Search of Relevant Theories and Principles. Health Education Ouarterlv. 27,290-3 06.

Friere, Paulo. (1993). Peda~oeyof the O~pressed.(M. Ramos, Trans.). New York: Continuum. (Original published in 1970).

Giroux, H. (1994). Disturbing- Phsures: Learning Popular Culture. New York: Routledge.

------(1996). Fugitive Cultures: Race. Violence. and Youth. New York: Routledge.

Goodall, N.(1994). Depend on myself: T.L.C. and the evolution of Black fernale rap. Journd of Nearo Historv,65,85-93.

Greenhaigh, S. (1996). The social construction of population science: an intellectual, insititutional, and political history of twentieth-century demography. Comparative Studies in Societv & Historv.38,26-66.

Gross, L. (1989). Out of the mainstream: Sexual rninorities in the mass media. In Seiter et ai. (Eds.), Remote Control: Television Audiences and Cultural Power (pp. 130-149). London: Routledge, 1989.

Grunseit, A. et al. (1997). Sexuality education and young people's sexual behavior: A review of studies. Journal of Adolescent Research. 12-421-453. 141 Guthrie, B. (1996). Girl Talk: Development of an Intervention for Prevention of HIV//AIDS and other Sexudy Transmitted Diseases in Adolescent Females. Public Health Nursine, 13,3 18-330.

Haraway, D. (1991). Simians. Cvborgs and Women. The re-invention of nature. Routledge: New York.

Harding, S. (1993). Rethïnking Standpoint Epistemology. In Alcoff and Poîter (Eds.), Ferninist E~istemoioaies(pp.49-82). New York: Routledge.

Hartley, J. (1982). Understanding News. London: Routledge.

Hatcher, R et al. (1994). Contrace~tiveTechnolow (16th Revised Edition). New York: lrvington Publishers.

Health Education Unit. (1 998). Mission Statement. Primary Health Care Department, Ministry of Social SeMces: Anguilla.

Hebdige, D. (1987). Tut and Mix": Culture. Identity and Caribbean Music. London: Comedia.

Hertzman, C. et al. (1994). "Heterogeneities in Health Status and the Deterrninants of Population Health" in Evans et al (Eds.), Whv are some people healthv and others not? The detenninants of health of po~ulations(pp.67-92). New York: Aldine de Gruyter.

Hodge, 1. (1998). National Youth Policv-Dr&. Anguilla: Department of Comrnunity Develoment and Welfare.

Hofferth, S. (1991). Prograrns for High Risk Adolescents: What Works? Evaluation and Program Plannine. 14.3- 16.

Holland, J. et al. (1990). Sex, gender and power: young women's sexuality in the shadow of AIDS. Sociolop of health and illness. I 2,336-3 50.

Holv Bible: New Internationaiist Version. (1 2th ed.) (1 988). Grand Rapids, Michigan: Zondervan Corporation.

Howard, P. (1994). The Confrontation of Modem and Traditional Knowledge Systems in Development. Canadian Journal of Communication, 19, 189-208.

Hughes, H.(1992). The Anguillian Revolution and Its Effects on Life. Twenty-fifih Anniversq of the AnmiIlian Revolution 1967- 1992. Anguilla: Government of Anguilla.

Immen, W. (1992, Match 4). Touring in Styie. The Globe and Mail Financial Times.

International Planned Parenthood Federation. (1995). Charter on SexuaI and Re~roductive Rights. New York: Author. Jemmot, J. and Jemmot, L. (1996). Strategies to Reduce the Risk of HIV Mixtion, Sexually Transmitted Diseases, and Pregnancy Among A6ica.n Amencan Adolescents. In Resnick and Rozensky (Eds.), Health Psycholow Throueh the Life Spn:Practice and Research O~~ortunities(pp. 395-422). Washington, D.C.: American Psychological Association.

Johnson, S. (1995). The Politics of Population: Cairo. 1994. London: Earthscan Publications, 1995.

Juhasz, A (1995). AIDS TV: Tdentity Community and Alternative Video. Durham: Duke University Press.

Kendall, Tamil. (1998b). Proposal for the National Adolescent Re~roductiveHealth Survey. Anguilla: Department of Primary Health Care, Ministry of Social SeMces.

------(1998a) Kev Findines and Reccomendations: National Adolescent Reproductive Health Survev. Anguilla: Department of Primary Health Care, Mïnîstry of Social Services.

Kidd, J. (1997). Oualitv Health Care: An Assessrnent of Oualitv of Care Issues in Anmilla- Anguilla: Department of PrÜnary Health Care, Ministry of Social Services.

Kirnbaii, M., Godez, R. and Zacarias F. (1 99 1). AIDS among Women in Latin Amenca and the Caribbean. Bulletin of the Pan American Heaith Organization.25,367-373.

Kippax, S. et al. (1994). Hetersexuality, masculinity and HIV. AIDS.8 (Suppl l), 3 15-323.

Kirby, S. and McKenna, K. (1989). Experience. Research Social Change: Methods fiom the Margins. Toronto: Garamond Press.

Kitzinger, J. (1993). Understanding AIDS: Researching Acquired Immune Deficiency Syndrome. In Eldridge (Ed.), Gettine The Message: News. truth and Dower (pp.271-304). London: Routledge, 1993.

Lipsitz, G. (1 994). Dangerous Crossroads: Po~ularMusic. Postmodernism and the Politics of Place. London: Verso.

Lupton, D. (1994). Moral Threats and Dangerous Desires: AIDS in the news media. London: Taylor & Francis.

Main, D. (1994). Preventing HIV infection among adolescents: Evaiuation of a school- based education program. Preventive Medicine.23,409-4 17.

Malson, H. (1998). The Thin Woman: Feminism. post-structuralism and the social psycholow of anorexia nervosa. Lcndon: Routledge.

Manuel, P. et al. (1995). Canibbean Currents: Caribbean Music fiom Rumba to Rem. Philadelphia: Temple University Press. 143 Margillo, G. and Imahori T. (1998). Understanding Safer Sex Negotiation in a Group of Low Income acan-Amencan Women. In Roth and Fuller (Eds.), Women and AIDS: Negotiatinn Safer Practices. Care and Representation (pp.43-70). New York: The Haworth Press.

Massiah, J. (1983). Women as heads of households in the Caribbean familv structure and feminine status. Paris: Unesco -

McConviiie, J. (1999, February 1). More than Just Music Ahead for BET. Crain Communications Inc. Electronic Media.

McKay, A (1993). Research supports broadly-based sex education. The Canadian Journal of Human Sexualit~,2,89-98.

Mens, S. and Fitzzatrick M. (1992). Thinking about Safer Sex: The Risky Business of "Know Your Partner" Advice. In Edgar et al. (Eds.), AIDS: A Comrnunication Perspective @p.1- 19). New Jersey: Lawrence Erlbaum Associates.

Moore, K. et al. (1998). A Statistical Portrait of Adolescent Sex. Contrace~tionand Childbearinq. Washington D.C.: The National Campaign to Prevent Teenage Pregnancy.

Moser, C. (1989). Gender Planning in the Third World: Meeting Practical and Strategic Gender Needs. World Develo~ment.17, 1799- 1825.

MSBet Launches Urban Express. (1 999, February 16). Business Wire.

MTVs Stephen Hill Joins BET to Head UP Music Programrning; Ranked 7th in the Source Magazines Top 30 Most Powerful Music Executives. (1999, April22). Business Wire.

Myrick, R (1996). AIDS. Comrnunication. and Empowerment: Gav Male Identitv and the Politics of Public Health Messages. New York: Harrington Park Press.

Nathanson, C. (1991). Dangerous Passage: The Social Control of Sexuality in Women's Adolescence. Philadephia: Temple University Press.

National Youth one day for on [sic] Semal and Reproductive Health. (1999, February 18). The Dailv Herald, p.9.

Nelson, N. and Wright S. (1995). Power and Participatory Develo~ment.Theoy and Practice. London: Intermediate Technology Publications.

Newman, L. (Ed). (1985). Women's Medicine: A Cross-Cultural Studv of Indiaeneous Fertilitv Remilation. New Brunswick: Rutgers University Press.

Nitz, K. (1999). Adolescent pregnancy prevention: A review of interventions and programs. Clinical Psycholoev Review. 19,457-47 1.

Olsen, J. (1991). The effects of three abstinence sex education programs on student attitudes towards sexuality. Adolescence.26,63 1-64 1. Paiva, V. and Skinner S. (1 996). Poor and Young: The Sexual Scene and Vulnerability to HIV in Urban Brazil. Paper presented at the M International Conference on AiDS, Vancouver BC.

Parker, R. (1995). The Social and Cultural Construction of Sexuai Risk, or How to Have (Sex) Research in an Epidemic. In Brummelhuis and Herdt (Eds.), Culture and Sexual Risk: Anthropological Pers~ectiveson AIDS (pp.257-270). Amsterdam: Gordon and Breach Publishers.

Petty, C. (1991). A Handbook History of Aneuilla. Anguilla: Author.

------. (1999, January 22). It's Harvest Time. The Anaiillian, p.3.

Pizzocolo, C. (1999, April 1)- Interview with TadKendail. The Anmiillian, p. 10.

------. (1999, March 26). Youth and Sexuality on Anguiila. The Anwiüian, p.6.

Rhatigan, J. (1 996). Rereadhg Public Health. Ln Farmer et al. Fds), Women Poverty and ADS: Sex. Dmas and Structural (pp.207-244). Monroe, Maine: Comrnon Courage Press.

Riano, P. (Ed.). (1994). Women in Grassroots Communication. Furthering Social Change. Thousand Oaks: Sage.

Richardson, S. and Kendall T. (1999). Priorities for Personal and Social Education. Anguilla: Aibena Lake Hodge Comprehensive School.

Roberts, R (1 994). "Ladies First" : Queen Latifah's Atiocentric Feminist Music Video. Afiican Amencan Review.28,245-257.

Roe, K. et al. (1995). Combining Research, Advocacy, and Education: The Methods of the Grandparent Caregiver Study. Health Education O~arterlv.27~459-475.

Rogers, F. (1998). E~idemiolo~caiSumrnary of HIV/AIDS in Anaiilla tiom Januarv 1988 to April 1998. Anguilla: Primary Health Care Department, Ministry of Social Senices.

Rose, T. (199 1). Never Trust a Big Butt and a Srnile. Camera Obscura.23, 109- 131.

Ross, C. (1999, April 12). 1s the African American Consumer Undervaiued? Advertising Aae, S 1.

Rotheram-Borus, M. and Koopman C. (199 1). Sexual risk behaviors, AIDS knowledge, and belief about AIDS among runaways. Amencan Journal of Public Health8 1,208-2 10.

Saint-Victor, R. (1986). Family Relations and Support Systems. In EUis (Ed.), Women of the Caribbean (pp.84-87). London: Zed. 145 Scanlan, A. (1 995). An HIV/AIDS Prevention. Peer Education Program: Deveio~ment. Irn~lementationand Formative Evaluation. Unpublished Ph.D dissertation, University of Idaho.

Schoepc B. (1995). Action-Research and Empowerment in Mca. in Schneider and Stoller (Eds.), Women Resisting AIDS: Feminist Strateaes of Emoowerment (pp.246-269). Philadelphia: Temple University Press.

Schrijvers, J. (1995). Participation and Power: A transfomative feminist research perspective-In Nelson and Wright (Eds.), Power and Partici atov Development: Theorv and Practiçe @p. 19-29). London: Intermediate Technology Publications.

Senior, 0. (1 99 1). Workine Miracles: Women's Lives in the Enelish-soeakinn Caribbean. London: Currey.

Shelton, M. (1997). Can't touch this! Representations of the Atiican Amencan fede body in urban rap videos. Popular Music and Societv.2 1, 107-1 16.

Shiva, V. (1993). Monocultures of the Mind. London: Zed, 1993.

------. (1 989). Stayine Alive. London: Zed.

_C______U_ . (1 992). Reductionist Science as Epistemological Violence. In Nandy (Ed.), Science. Heeemonv and (pp.232-256). Delhi : Oxford University Press.

----- and Radha Holla-Bhar. (1996). Intellectual Piracy and the Neem Tree. The Ecoloeist.23,223-227.

Sirnmons, J. (1996). A Global Perspective. In Farmer et al (Eds.), Women Poverty and AIDS: Sex. Drues and Structural Violence (pp.39-90). Monroe, Maine: Cornmon Courage Press.

Sobo, E. (1995). Choosing Unsafe Sex. AIDS-Risk Denial Amone Disadvanta~ed Women. Philadelphia: University of Philadelphia Press.

Sosnowitz, B. (1995). AIDS Prevention, Minonty Women, and Gender Assertiveness. In Schneider and Stoller (Eds.), Women Resistinq AIDS: Feminist Strateeies of Empowerment (pp. 139- 16 1). Philadelphia: Temple University Press.

Statistical Unit. (1992). Census of Population. Anguilla: Ministry of Finance and Economic Development.

______-HI. (1996). Vital Statistics Summarv. Anguilla: Ministry of Finance and Economic Development.

------. (1997). Abstract of Statistics 1996. Anguilla: Ministiy of Finance and Economic Development-

Sussell, R (1992). News of An Epidemic: Explorhg the Discourse of "Deviance" in the Construction of AIDS. Unpublished Masters thesis, Concordia University, Montreal. Tait, A and Barber J. (1 996). Black Entertainment Television: Breaking New Ground and Accepting New Responsibüities? In Beny and Manning-Miller (Eds.), Mediated Messages and Afncan Amencan Culture @p. 193-214). Sage Publications: Thousand Oaks, Calif.

Thompson, Kenneth. (1998). Moral Panics. London: Routledge.

Tolman, D. (1994). Daring To Desire: Culture and the Bodies of Adolescent Girls. In IrWie (Ed.), Sexual Cultures: Adolescents. Cornmunities and the Construction of Identity (pp.250-284). Philadelphia: Temple University Press.

------and Tracey E. Higgins. (1996). How Being a Good Girl Can Be Bad for Girls. In Maglin and Perry (Eds.), "Bad Girls"/"Good Girls": Women Sex and Power in the Nineties (pp.205-225). New Jersey: Rutgers University Press.

Travers, M. and Bennett L. (1996). AIDS, Women and Power. in Sherr et al. (Eds.), AIDS as a Gender Issue: Psychosocid Persbectives (pp.64-77). London: Taylor & Francis.

UNAIDS. (1997). E idemiolo~calFact Sheets on W/AIDSand sexuailv transmitted di seases (Cari bbean). Geneva: Author.

------. (1995). An Overview of Selected Curable SexuaUy Transmitted Diseases (www. unaids. orglunaids/std/akagmer).

------. (1998a). Status and Trend of the Global HIV/AIDS Pandernic, Official Satellite Symposium, July 5-6, 1996 (www.unaids.org~unaids/docwnent/epidemio).

------. (1998b). Women and AIDS: Agenda for Action (www. unaids. org/unaids/document/women~agenda).

------(1 998c) Youth: A Force For Change (www.unaids.org/unaidslevents~wad/l998/force).

United Nations Family Planning Association. (1 998a). Carribean Youth Exdosion Guidelines. Barbados: Author.

------.(1984). Evduation of Various Familv Life Education Proiects with Particular Em~hasison Youth in the Endish-Speaking Caribbean. New York: Author.

-----. (1998b). Regjonal Action Plan (RAP) of Brideetown, Barbado- October 5- 7. 1998. Barbados: Author.

------. (1998~).A Reaiond R~PWith Adolescents About Sex Marriaae. and Choices. Barbados: Author. ______-. (1998d). Report of the Round Table on Adolescent Sexuai and Reproductive Health: Key Future Actions. New York A~ril14- 17. 1998. New York: Author. 147 --- . (1998d). The Sexual and Reproductive Health of Adolescents: A Review of UNFPA Prowarnme Experience. Technicd Re~ort43. New York: Author.

United Against Homosexuality. (1 999, March 19). The Aneuillian, p. 1.

Waldby, C. (1996). AIDS and the Bodv Poiitic: Biomedicine and Sexual Difference. New York: Routledge.

Watney, S. (1989). Poiicina desire: oornoaa hv. AIDS. and the media. Minneapolis: University of Mi~eSOtiiPress.

Weiss, E. and Gupta G. (1998). Bridaina the Gap. Addressin Gender and Sexudity in HIV Prevention. Washington, DC: International Center for Research on Women.

WEMOS. (1992). A Ouestion of Control: Women's perspectives on the development and use of contraceptive technoloeies. Amsterdam: WEMOS Women and Pharmaceuticals Project.

Westlake, D. (1972). Under An Endish Heaven. Hodder and Stoughton.

Wheeler, RW. and K.W. Radcliffe. (1994). HrV infection in the Caribbean. International Journal of STD & AIDS,5,79-89.

Williamson, 1. (1989). Every Virus Tek a Story: The Meanings of HW and AIDS. lin Carter and Watney (Eds.), Taking Liberties: AIDS and Cultural Politics (pp.69-80). London: Serpents Tail.

Wilton, T. (1 997). EnCienderina AIDS : Deconstmcting Sex, Text and Epidernic. London: Sage Publications.

Winter, L. and Goldy, S. (1993). Effects of prebehavioural cognitive work on adolescents' acceptance of condoms. WthPsycholow. 12,308-3 12.

World Health Organization. (1998). World Health Day: Safe Motherhood, Delay Childbearing (www.who.int/whday/en).

Youth Consultation in Anguilla. (1999, February 26). The AnailLian, p. 16.

Zeller, R. (1 993). Focus Group Research on Sensitive Topics: setting the agenda without setting the agenda. ln Morgan (Ed.), Successfiil Focus Grou~s:advancing the state of the art @p. 2 67- 183). Newbury Park, Calif: Sage. Appendis 1: Adolescent Reproductive Heaith Suwey

This survey is meant to give you a chance to vaice your VIoughts and anœrns. Your answiers cm help Anguilla create health semecesthat give Wung people what they need and want,

DO NOT WRlTE YOUR NAME ON THIS PAPER.

THIS IS NOTA EST: Yourname w7I NOTbeon thesuNey No one wiCI knowyouranswers- hase be as honest as you can, Your particpatron is wfunfary- You do nof have to anmerany qI#SbOn tnat pu do not want. We need your help. It is the most important part of the survey Thank you. Little Abut YOW~ Have you gone to the Prinass Alexandra These are a faw general questions Hospital for medicri semices: about you, whrt you do and pur O In tbe iast 4 weeks plans for the future. O In oielast year O More than a year ago Si- you started high school O New

How oîd are you? Have you gone to a private chfor or dinic in Anguilla for &id micas:

ln the last 4 weeks In the last year Am you a -ber of uiy clubs, youth Q Morethanayearago groupr, sports team, church O Since you stated high school associationr? Nevef

0 Yes O No Have you goria to a private deror cfinit in St, Martin or dsewtmm for rnedid Do you plan to finish high school safvbs:

O Yes O No In the last 4 weeb 0 Inttiefastyear O Morethana yearago 0 Yes 0 No 0 Since you started high schod O Never

if ywwem going to dla teiephone hotline for infocmation, the W tima Tho nmxt qumrtlorn rsh how would be (pi& O-): you vlrlt docbrr, cUnl- or borpdtab and rrhat smirtcas wovld k ks8 0 Dunng worlung haurs and mort comœnkrit mr pu, (8arn-12pW1-4pm) l O O~finglunch hour (12-1 pm) a ARer çchooi (3:3G5:30) O In the evrning (530-7:3û). 0 6) Hmpu gone to a public h..l(h dhic for , O On the -ng the day madial seMcas: O On ttie weekend in the evetning 4 Ottiar In the last 4 waeb / in the tast year / 11) l?œ Mors than a year ago kct place for a hmaM dinit #' espaàaily for young peapk would bc Since yar stvtrsd high sciiod #' New / in the Valley / O in the xhool / 0 in the pubiic hdîh dinics 0 0th- 12) If you were going to visit a heaith ciinic on 15) How much time eveqj WEEK do you spend your own 9 watching television? (VATHOUT your parent or guardian), / bes: the tirne wouid be (pi& one): /* None 6-9 hcurs a about 30 min a 1&15 hours 12 Dunng working hours i a 1-2 hou= more than 15 (8 am - j2 pml1- 4 pm) J O 3-5 hours houn 0 Duing Icncfi hour (12-1pm) I a A3or school (3:Yû-530) > in the evsning (530-7:30). / 16) What a= your two fmourite television On the weekend during the day f channels: On the weekend in the evening / Cther #' # 73) The next question asks about gemng / reproductive heafth infornation and How often do you watch (mark JI piease~)? senrices. Condoms, pamphlets about Aflœ A - I(rr pregnancy , contraceptives, an AfDS test, - nnd answeo to questions aômt sexuality > CaribScope 000 ansome emamples of reproductive hul(h 8 CaribBusiness 00 information and temices. # Anguilla Diary 000 Chi& Minbîer's Addmss O O O Have you gone to any of the following to get reproductive heakh infonnatbn or How much tim evcny WEEK do you spend (mark ah for you): sewices ail that tme Iistming to the radio? Public clinic in Anguilla a Nom Pnncess Alexandra Hospital O about 30 minutes Family Life and Heath Education Unit R j-2 heurs Pnvate Oocbr or Clinic in Anguilla 0 3-5 hou= Doctor or Clinic in St Martin 0 6-9 Doctor Clinic elsewhere or 0 la15 hows (not St Marün) more 15 hours None of the above than #' 19) Which radio -ans do you lis- ta tnost otten (pi& two)? Communication: Caribbean bacon (Anguilla) Radio Anguilla (Anguilla) 94.7 FM (St Mahn) '105.7 FM (Anguilla) p' 14) How much time every MWdo you spend / 107.5 FM (Anguilla) 1 02.7 FM (St.Martin) mading books, mwspspam or magazines / for entertainmerrt ( NO1for tchool)? 107.9 FM (Antigua) d' Radio Patadise (News) VON Radio (News) Other How offan dc you listen to How much time every 'NE=< Co you spend "Youtfi to Youth"? fn church and at c)rurch rehted hrnctions (Youth groups, bible stidy etc.)

O None n 1-2 ~OWS 0 3-5 murs How oRen do you go to the Libnry? O &9 hours u 1&1S Murs Rarely or Never O more than 15 hours O Omeamonth 0 Ocia?e~~Wee!ks O Onœaweek Cl More than once a week Do you use the Intsma3 (at home or at the iibnry)

O Yes 0 No

The next question asb who ywfalk to. PIease Wl us if you agfet, agme somswhat or dbagree with the following stotaments.

Ag-

a) I cmtell my mom any of my pruôlems...... O

c) I have an adutt Mmd (rdative, temer, pastor) that 1 cm disarss rny problms with ...... O d) People in my family understand me ...... Ci, a) 1 have disaissed how pregnancy happeru with my mom or my âad or the adult I live witn ...... R b) fhere is an adth I disam sex adsahrrlity with ...... O c) I wwld likb bo talk mone abart reiaümships

and sexuaiii witn my mom ...... ity...... ity...~ d) I wuld like to talk more about hlationships and sexmüty witti my ded ...... How do you learn about sex? If you had questions about the changes in (Pick the two most important ways) your body, relationships, pfegnancy, cmtrac9ptives or HNlAIDS aie best way Frcrn Friends to get ariswers would be! to talk to (pick two): From Parents From Non-Fidion Books and People yow own age Magazines &aineci as educatws From Fidion Books Nurse or Doctor Fmm Movies and N Guidarice Counselor From Family Life Teachers and Confiâentiaf telephorie infonnatiori Health Educatars line Mi& is the best way for you to A parent or the adult you I'm with generai information about HNIAlDS, Somme from yow church, youth preqnmcy, seurlly trursmithd diseaw mgankation, sports team @astoc and puberty? (pi& one) youth leacbr, coach) Teachers 0 Pamphlets and posterz Health Educator 0 Radio O In school (Personal and SoGial Who do you talk to about $ex? Mucation, guest speakers) 0 Television O A parent or the adult you live with Cl Churcb O Brothers / Sisten O An aduitfnend 0 Boyfriend 1 GirMiend O Friends O No one

[ Remember this is not a test, we just want to howwimt you think. J

You CAN get AlOS from king bit by a It is mom dangsrous for a manto have mosquito. a baby man to Wce the birth controi pill.

0 Tme O False O True O False

Woridwide, most people get AtDS through having sex with people of the urne sen Teenagers crn get fme contmcspüves (Homoscxuality). (condoms, pills, the injection) at AnguiIlian balth dinics. 0 Tnte 0 False

An AlDS tesi tiken 2 wwûs to 3 months atar having unprottctad sux will give truc msults. If 100 women have s8x wfthout using a contracaptiva for one year, rpproximately 0 Tnie O False how many will gat pmgnant? 309) The picture below shows the woman's menstmal cycfe. Picl the the in the ojcle (A, 8, or C)mat you #ink a woman is most Iikely to get pregnant:

r Sex is &en an impo-nt part of pwpIeWslives. It is vary private, but we hope you wf31 shan soma information witb us to hefp us understand the conemms for teenagers in Anguilla, Remamber, your aruwerr rrœ wirfiômtfrl and wïli be kept private.

31 ) Have you had any sexual e-ence The fimt time you had =x, ware you (French kissing, Yeeling up")? pmssured into it against your will?

O Yes 17 Yes O No O Sortof cl No 32) Have you ever had sex? O Doesn't apply to me

0 YES How old were you aia first time you had YES but a long time ago $ex? O NO because (If yous/e rnarked NO, seied al1 the reasons 7 yean dd or younger that apply to you): O 8yearsoM 0 14yearsdd

r 4 O 9 years dd [3 15 years dd I ta I older want wait unül am O 10 years oid O 16 years dd am O 1 want to wait unbl I rnarrïed O 11 yean old O 17 years old I don't ta nsk beming pregrian O want O 12 years old 0 18 years old or getting sorneorie pregnant O 13 yean old 1 haven't had the chance to have sex wiai somme 1 ik? C3 Doesn't appIy to me I am scared of getting a disease Was the fi- person you had sex with My religious values are against it My parents values are against it O Your age 5 I jwt don't feei fike it (don't feel the need to have sex) O Olderthan you O I have had sex Haw much Nef? Years 0 Doesn't apply to me * 4 0 Younger than you Was the fiirt time you had sex: Haw much youngeî? years

O Plannecl (you deuded to do it befwe it O Doesn't apply to me twPef=o a Unplanned (it just sort of happeneci) CI Doesn't appfy to me / How nany sexual pârtnem have you had , 41) Have you ever been pregnant or made dunng your Me? /' sameone pregnant?

One of us kept the baby We are raising the baby together One of ow famiiies kept the baby Adopîion The Iast time you had sex, did you Mkmhge(the baby died belOre birth) or your putnar usa any of th. following Abortion (Mark al1 mat are ûw for you) ? Pregnant naw and dorit kmw what to do R Mkdidn'tweanyoiing I dari't know Mat happmd O Coridorns(nrbbers) Doesn't appiy to me 0 -waigauf) a RhyuunMethod (comüng the days since Friast Pe-3 Have you ever had an AlDS tost? O Brtti coribd pills, the iipctiari,Norplsnt R An IUD 17 The sponge, cfearn, foam, diaphragm f' or fernale cordom 44) Have you mmbeen tesid for a sexuaily ' O Moming-after piil or RU486 / tnrtsmitted dhse(pox, daps, kak) 3 Other

O Doesn't appiy to me

How oRen Co you and your partnw um condoms? / O Yes 0 No / 5 46) nYr.who-n O A boyniaridlgidfrknd #' O Angmupwholiveswithme / a An gmwn up wim doesn't live wiVi me. / but Mois dose to my family How oCtsn do you or your putnsr use / birth corrbd (imiuâicrg coridoms)? a Aroaisr teenager, bmîher a sister who / fives wiîh me Please tail us if you agree, agree sarnewtrat or disagree wi# the fdtowing staternents.

If I tefl a dactor or nurse at the hcspitat or public dinic sornething penonal, my parents or othér peapie in the cornmunity will NOT find out ...... a

If I had an AIDS ?estat the hosptal, my resdts wouid be kept private...... 0

I could tell a sctiod guidance CrJunselor ariything and !bey worild keep it a secret ...... a

ln Anguilla. a telephone haine is anonymous (no one mldknw it was yau caUing) ......

Teactiers do nof tak about the rilesand persocral problems ~studerrts...... n

I wouid tell my parentr about ANY hedîh probiems that I had...... n If I had sex uhîhout a condom. I woJd take an AIDS test even if the nurse or dodor ddtdl my parents...... L!

The next -on uks soma of your ideas about sexuality, condoms and datioristiips. Yw do NOT have to have had sex to answsr these qucc5dion. Just let us howwhat you think by marking if you agree or disagres with the fdlom'ng statwmnfs.

In a good teenage dationship, sex isn't important ...... a 0 Condoms (Nbben) provide very ef¶èaivepotdon against HIVIAIDS ...... a Girls want sex as much as boys...... LI O

Dodon and nurses thi* teenagers hving sex is OK...... a 0 I worry sbout HIVIAIDS...... a O

Girls shouid take respmsiôility for birth contrd...... 0 O

Abstinence (no sex) is the best choice for temm...... O I feel anfident i couid use a condom or ask my pamer to use s condom ...... --.-----....----.-.-a

The first tirne/ next tirne I have sex, I plan to use a condom ......

Mcst men will tell a woman anything ta get them to have sex...... a

Most Anguitlians don? have sex until they are rnam'ed...... 0

l kmw where I can buy condoms and haw much they cost ......

Having many girtfnerids proves you are a mai man......

Mat1 do sexualfy isn't very important to who I am as a person-......

Having a chiid shows you are grown up ...... a

A good age ta sbrt havfng sex is: a 10-13years 0 14-16 years a 17-t8years O When you get mamed