Peace Corps Service and HIV Disease: Practices, Risks, and Benefits

-Suzanne Marks, RPCV Togo

A question often asked of Peace Corps recruiters by participants at Gay Pride events is: “Can I serve as a volunteer if I am HIV positive?” Peace Corps’ official policy states that the agency does not discriminate on the basis of disability and that it must provide reasonable accommodation for persons with disabilities, in accordance with the Rehabilitation Act of 1973. (Note: The Americans with Disabilities Act of 1990 protects HIV-infected individuals from discrimination by private employers of 15 or more employees, and by state and local governments). However, to date, no HIV-infected applicant has been accepted for Peace Corps service. At a time when protease inhibitors have rendered HIV disease a manageable health condition for many and when persons with HIV disease can provide much needed health education about disease prevention and management to the ever-increasing numbers of HIV-infected in developing countries, the practice of excluding those with HIV disease from Peace Corps service, regardless of policy, is called into question.

To be offered a Peace Corps volunteer position, an interested individual must complete an application form and be medically qualified. While the Peace Corps application does not explicitly request HIV status, it does ask applicants to report their medical history, including infectious diseases. If an applicant responds that s/he has HIV disease, then the health condition of the applicant is assessed. If an HIV-infected person does not voluntarily disclose her/his status, then the required medical exam soon reveals that fact, since Peace Corps policy states that applicants must be HIV tested.

Since 1986, HIV testing has been performed on all applicants prior to service and again at close of service. One reason for this policy is to determine baseline medical status upon entry and post-service medical status to aid in determining valid workers’ compensation claims in the event of disability caused or exacerbated during Peace Corps service. As of 1998, approximately 20 cases of HIV infection have been documented among volunteers since testing began. Another reason for HIV testing is to enable Peace Corps to examine the health status of applicants, so that their medical qualification for posts can be realistically assessed and accommodations made, if needed. The primary motivation underlying the practices of the Office of Medical Services is to protect the health of US citizens serving in the Peace Corps. Medical qualification is based on an applicant’s medical prognosis and on Peace Corps’ ability to meet her/his medical needs, including an assessment of how quickly the volunteer can be provided emergency medical care, if the need arises, and an evaluation of a worst case scenario.

Peace Corps has quite a history of accommodating various disabilities, such as blindness and diabetes. For example, a diabetic volunteer required use of an insulin pump, an uninterrupted supply of insulin, and regular medical monitoring, including lab tests of specimens. When asked whether the cost of accommodating a medical condition figured into the qualification process, the Office of Medical Services stated that the costs of care were not among the determining factors for medical clearance. However, costs might be considered at a higher level in the Peace Corps application process, such as at a policy level. Currently, no policies exist barring expensive medical conditions. But theoretically, an accommodation for a disability may become an undue hardship when it becomes costly, extensive, disruptive, or fundamentally alters the nature or operation of the business. Since the current annual cost of anti-HIV medications is approximately $15,000, and since Peace Corps would be required to pay this cost (excluding the first six months of service, during which the volunteer would bring a supply of medications), resource availability and constraints may become relevant if substantial numbers of HIV-infected individuals applied to the Peace Corps. Costs of accommodating a medical condition are covered either entirely by Peace Corps headquarters, entirely by the post, or are shared by both entities.

Besides medical qualification for service, applicants must be considered “suitable” for their posts. Among considerations of suitability is the acceptability of the medical condition by the culture in which the volunteer would serve. For instance, some cultures do not accept individuals with seizure illnesses such as epilepsy. Given the high prevalence of HIV disease in many developing countries, cultural acceptance of those with HIV is likely to be higher than for persons with diseases that are rare or unusual. However, legal barriers to acceptance of persons with HIV disease exist in countries, like the US, that prohibit entry of HIV-infected individuals.

Peace Corps headquarters weighs the risks and the benefits of each applicant, before deciding to offer a position. Are the skills and abilities that an HIV-positive applicant brings to Peace Corps service worth the risks to that individual’s health? The opinion of a source in the Office of Medical Services is that, currently, the risks are greater than the benefits for most HIV-infected individuals. The high incidence of diarrheal, parasitic, and other infectious diseases among volunteers with functional immune systems suggests that Peace Corps service would be detrimental to the health of HIV-infected individuals. Other organizations and agencies, such as CARE, CDC, USAID, and WHO, are also formulating policies and practices vis-a-vis HIV-infected applicants. Of interest would be the consistency in policies/practices and the actual experiences of HIV-infected employees placed in long-term positions in developing countries. The net risks/benefits depend greatly on the health status of the applicant and on the circumstances of the post. Access to high quality water, food, and needed medications are essential. Also to be considered are prophylactic medications that may lessen an individual’s risk of acquiring diseases. Tuberculosis (TB) is the most common opportunistic infection determining AIDS in the developing world. However, prophylactic medications exist to prevent TB disease. And, if disease develops, TB is as curable in HIV-infected persons as it is in non-infected persons. Peace Corps will help applicants make informed risk/benefit calculations regarding their decisions to continue with the Peace Corps application process. HIV-infected persons who are considering applying for Peace Corps service may contact the Office of Medical Services at 800-424-8580, extension 1500.

The many facets of the decision to send HIV-infected US citizens into developing countries as Peace Corps volunteers highlight the challenges and realities that millions born and living in developing countries face daily in their struggle to survive HIV infection. The developed world has been criticized for their two-tiered approach to preventing and managing HIV disease: with the provision of anti-HIV medications, intensive medical monitoring, and needle exchange in the US and Europe compared with the focus on condom use and partner reduction in Africa, Asia, and Latin America. Since one of Peace Corps’ three goals is to bring the experiences of the developing world back to the US, HIV-infected Peace Corps volunteers can help bridge the gap in the application of AIDS prevention practices and technologies.

A Letter from Australia for Couples Considering Volunteer Service

-by Michael Tatham, May 1998

Editor’s Note: While we were preparing this issue, which focuses on questions that usually come up at the Gay Pride events, a related e-mail from Australia arrived out of the blue. The author has given us his permission to adapt it as an article.

I came across your web site recently and was interested in the issues you discuss concerning same sex couples and the Peace Corps.

I was a volunteer in Thailand with the Australian Volunteers Abroad Program administered by the Overseas Service Bureau with my partner Peter from 1995 to 1997. The experience was an interesting one. Whereas the OSB was ok about placing us (a lesbian couple was placed in Africa at the same time), the fact we were together was cause for some consternation with our host agency in Thailand. It was not until we received permission to move to separate organizations that we felt we were being treated on our own merits rather than as an oddity. Sometimes it seemed that our host felt obliged to accept us as volunteers in order to maintain an ongoing relationship with OSB.

The fact that we went to the same host organization (albeit different branch offices about 20 km apart) meant we were treated as being the same, having the same values and being stereotyped along the same lines – a fascinating experience, if a little wearing. And, as for the myth of universal acceptance of homosexuality in Thailand, yes it is – a myth.

There were many stresses on the relationship that would otherwise not have been there, and yes one did have a better job than the other, but we also had different attitudes to the placement as well, so coping was an individual as well as a joint experience. We were there for the duration of the two year program, and are still together.

There is a perception in Australia of a “free and easy” sexuality and acceptance of all diversity in countries like Thailand, sometimes perpetuated by Thailand’s own ambiguous tourist promotion as well as our own lack of in-depth cultural understanding. I sometimes feel I have to constantly remind people (including myself) that there is in Thailand, like in all societies, different levels of acceptance. We have wonderful Thai friends of all genders and persuasions. We were lucky to recently invite one friend to visit us who had a great time showing us our town from his perspective.

As far as I know, OSB continues to place gay couples if they can, so long as their skills and positions match. While this may be difficult to do in the countryside, in big cities it should be easy. I would recommend couples who want to be placed together keep trying to get through the discriminatory Peace Corps policy somehow, as ours was an experience unique and exciting in its realization.

Some Perspective for Gay Couples Considering the Peace Corps

-by Joe Terteling, RPCV, May 1998

Editor’s note: Joe Terteling, former volunteer in Sri Lanka, gay man, and former Peace Corps recruiter in Seattle, gives his views of questions most frequently asked by gay domestic partners considering Peace Corps. He offers suggestions and undermines some myths.

I fear domestic partners considering Peace Corps are down on their luck for a number of reasons.

Peace Corps doesn’t accept unmarried couples of whatever gender combination. Go figure. But even if Peace Corps did, the first strike against gay/lesbian domestic partners serving would be the same difficulty Peace Corps has in placing married couples overseas. Married couples have a notoriously difficult time landing a volunteer assignment, because Peace Corps must find some village on the planet with two official Peace Corps jobs waiting, one for which each spouse is qualified, and with housing for the couple available in the same location. Although meeting the job and housing criteria may sound easy, it isn’t. Couples applying to Peace Corps endure a wait easily twice as long as do individual applicants – if an assignment ever comes. Even spouses possessing red-hot degrees or experience in, say, agronomy and nursing, are going nowhere with Peace Corps unless some country has need of a couple possessing these skills.

Unable to serve, gay couples frequently ponder ways around the marriage barrier. Here are common schemes I’ve heard repeatedly from gay couples, and occasionally from unmarried straight couples, too.

We’ll both secretly apply for the Peace Corps at the same time, hoping we’ll be placed together. Please dismiss any dream of being assigned in the same place; much less the same country; much less the same hemisphere. If you’ve got different skills and interests and educational backgrounds, you’d be matched to different jobs. Some countries ask for certain skills, others don’t. Different programs start at different times. Programs get canceled. A volunteer pulled out of one country due to instability may be reassigned to the job “promised” to you: so you get bumped to a program leaving three months from now to Kazakhstan. Meanwhile your lover has a ticket for Ecuador in her hand.

Our love is so strong we can serve as volunteers in different places. I watched Donna and Alan, old sweethearts, serve in Sri Lanka and Kenya, respectively. In the first year Donna visited him in Kenya. He visited her in Sri Lanka the next. They’re now raising kids in Pennsylvania. But I imagine two years on different continents might strain any relationship.

I’ll just do Peace Corps while my lover waits for me back at the condo. Keep in mind that people of whatever sexual orientation in romantic relationships of whatever sort are statistically more likely to quit Peace Corps and come home early if they’ve left a love behind. It’s a human thing.

I’ll secretly fly my lover over once I’m settled in my village. I can’t recommend this approach due to lack of a job for your partner, lack of Peace Corps preparatory training and health care, possible social stigma, unavailability of housing, and the like. Every anecdote I know of a volunteer importing a lover ends in disaster. My friend Maggie brought her lover Richard to Nepal. They were married there, as the striking photos of Maggie in a red sari and dripping with gold jewelry attest. But Richard left after a few months. They soon divorced. Another thing that can happen is that an intimate relationship can impede language and culture acquisition. Instead of “getting into the culture” the partners spend more time “getting into each other.” And sometimes one partner bonds with the culture, and the other doesn’t.

Until Peace Corps accepts gay domestic partners, you do have avenues to working abroad, but you’ll have to research each thoroughly.

Ask your nearest Peace Corps recruiting office for its most recent list of alternative international agencies doing development and volunteer work abroad. There are many dozens of Non-Government Organizations (NGOs) doing remarkable work overseas. Ask the Peace Corps office about volunteering for the United Nations. Consider short jaunts with organizations like Habitat for Humanity, thereby building up your resume of overseas experience. Check the library for books on how to work abroad.

Consider working overseas for a gay-friendly corporation which will support you both.

Bone up on a language together, travel to a place interesting to you where its spoken, and look together for some serious long-term volunteer work. The South Pacific might be ideal, where people are usually less shackled with sexual stigma than here. Our LGB RPCV Mentor Program can put you in touch with former volunteers who worked in parts of the world that interest you.

Attempt In-Country Admission. This is a real long shot, but possible. People wishing to be placed in a particular country can travel there and petition the Country Director, but success depends on positions available, your skills, availability of language and/or cultural training, available sites, your medical histories, discretionary Peace Corps Country budget, and many other details. In other words, you’d have to be extremely lucky, and the couple (gay, straight, or any combination) would need a wad of cash to live on while they wait to see if it works out. But strange things happen, even in the Peace Corps.

I regret the dour overview, but these are the realities as I see them. There are occasional stories of gay domestic partners assigned to different places in the same country and their impassioned weekend meetings, and there are anecdotes of gay volunteers who somehow partner-up in remote and isolated areas. But these happy tales seem much the exception.

I think it’s vital for gay domestic partners interested in Peace Corps to let Peace Corps know you’d apply if you could. I want the Peace Corps to know of the presence and interest of gay couples, for without a constant tap on the door I fear the agency will never consider such a possibility.

Finally, I want to note that as an individual your sexual orientation is a non-issue for Peace Corps. There are tons of gay people in the Peace Corps at all levels of the organization: in Washington D.C., the regional recruiting offices, staff overseas, and as volunteers in the field. You’re welcome as a gay person.

I encourage you to call or visit your nearest Peace Corps recruiting office and get a second opinion on my views. Good luck, and, as they say in Sri Lanka, “May the Triple Gems Bless You.”

Joe Terteling was a volunteer in Sri Lanka from 1984 to 1986.

Peace Corps’ Statement on Diversity

“An organization that represents America should be representative of America.”

The diversity of the American people is a large part of what makes America the country it is. Diversity of ethnic backgrounds, life experiences, and beliefs have strengthened our country in countless ways. And because the Peace Corps shares with the rest of the world our most precious resource — our people — it can carry out its mission only if the Volunteer corps truly represents America in all its diversity.

Since 1961, Peace Corps Volunteers have helped people in developing countries around the globe overcome the adversities they face and improve the quality of their life. Volunteers have brought that experience back to communities across our country, which has helped America respond to many of its own challenges. This has made the Peace Corps a valuable experience for people of every background, including African Americans, Hispanic Americans, Asian Americans, and people of other ethnic groups who are so important to our country’s past and its future.

To be sure, there are many communities in America that need and deserve assistance. But the Peace Corps can provide you with a new perspective on the world, a greater understanding of the problems in your community here at home, and provide you with the skills to help solve them.

In today’s competitive world, there is often a great deal of pressure to use one’s education to take the first good job that comes along. The Peace Corps, however, can often lead to more and better opportunities. Serving overseas as a Peace Corps Volunteer can increase your marketability here at home. Volunteers return with valuable technical and cross-cultural skills, knowledge of a foreign language, a financial readjustment allowance (up to $5,400 if you complete your training and two years of service), and the chance to participate in the Peace Corps’ graduate school programs — the Master’s International Program and the Peace Corps Fellows Program. This will put you in the enviable position to succeed in whatever career you choose.

The Peace Corps is an exciting opportunity not only because of what you can accomplish while serving as a Volunteer, but also because of what you can accomplish when you come home. That’s why the Peace Corps continues to attract the best and brightest people from every ethnic background, from all over America. “

Welcome to Peace Corps! Welcome to Training!

-Roy Schachter, RPCV Honduras, Peace Corps Staff Latin America

“Hi, I’m going to be your small business technical trainer. Nice to meet you, so glad you’re here.” And so begins the process of getting acquainted with a new and enthusiastic group of Peace Corps trainees. “Oh, by the way, I’m gay, so if any of you are curious about gay issues here in Guatemala (or El Salvador, Honduras, or Bolivia), I’d be happy to share my perspective. And if anyone in the group is interested in information about gay life in the local community or support available in the Peace Corps, we can talk about that also.”

But the reality is – I was never “out.” I worked six cycles of technical and one of cross-cultural training in four Latin American countries from 1993 to 1996. Although I’m sure some trainees and staff knew about me, it was never discussed. I attended meetings of the LGB Volunteer’s support group in Guatemala (Cuates). I went out to gay bars in countries that had them. I socialized openly with other gay people, both local and volunteers. During one training cycle, I even came by the Training Center with my partner (my friend, as I introduced him). But I was only really “out” to some of the Peace Corps nurses, telling them that I was available as a resource for trainees who revealed they were gay.

Ideally, a gay trainer would be out and available for any of the trainees who could use his/her guidance or insight on gay related issues in a particular foreign country/culture. But it’s not so easy. It’s interesting that gay or bisexual volunteers, who are open with their sexuality, often feel quite comfortable sharing this within the Peace Corps community, but rarely at their assigned work sites. Most feel that being out in their work environments in a culture usually less accepting than our own problematic society would adversely affect their acceptance and integration into their communities. And they’re right. But in Peace Corps, a volunteer can find a piece of Americana, usually with acceptance, respect and compassion toward gay volunteers by many of their fellow volunteers and the American Peace Corps staff. In fact, if they come across any overt discrimination within the Peace Corps they can make an issue of it and fully expect Peace Corps to back them and support them.

Ironically, for a trainer, the Peace Corps community is her/his “site.” For many of the same reasons that volunteers choose not to be as open at their sites, I felt that it was not in my best interest to share the fact that I was gay. I often worked closely with local staff to coordinate training activities. Most of the training staff were local people who often carried with them the same mixed bag of acceptance and prejudices as the local community. Staff at the Peace Corps office was also predominately local. From time to time I heard or heard of homophobic comments or attitudes, only confirming my suspicions about the risks involved. Being out could very well have presented problems. Some trainers and volunteers are out and open about their sexual orientation, and I admire those who were. I wish I could have been a bit stronger, a bit more self-confident and taken on this additional challenge. But, I wasn’t ready at the time.

One of my favorite training sessions was on diversity, an issue close to my heart. Who better to understand what it’s like to be different? It was a challenge to select, adapt, and develop activities that would generate worthwhile discussions and have people truly examine the whole range of diversity, including sexual orientation. All too often diversity or sensitivity training is met with resistance. Many people don’t think they need it, and others are unwilling to examine or consider changing values, beliefs, and behavior. The irony of addressing these issues with Peace Corps volunteers is that the volunteers welcome being thrust into working and living in a foreign country, and almost always come with open minds about learning and accepting a very different culture. But, they are often unaware of the unique challenges faced by other volunteers because of individual diversity issues like gender, sexual orientation, race/ethnicity, marital status, age, political or religious beliefs – those issues that identify a volunteer as a minority within the majority Peace Corps community.

Sometimes these diversity sessions worked well. Generating discussion and having people consider the challenges and advantages of diversity and the perspectives and problems faced by others was rewarding. But on other occasions it was very hard to get staff or volunteers to truly consider how their behaviors and attitudes affected others. It was strange conducting diversity sessions and not being out about my own diversity. I imagine that some of the participants wondered about my enthusiasm for the topic.

Sexual orientation, other than heterosexual, is an intriguing diversity issue, because it’s often a “hidden” diversity. In one session, a gay volunteer pointed this out, advising the group to be aware of inadvertently insulting a gay person, regardless of their feelings about homosexuality. I think most lesbians, gays and bisexuals have experienced this kind of situation. After this session, I overheard one of the trainees discussing his problems with gay sexual orientation. “But it’s abnormal, completely abnormal,” he said. I stepped up and asked what he had been referring to. “Nothing,” he responded. I pursued the issue until he confirmed that he thought “it” was “just abnormal.” Not ready to reveal myself, I asked him how he would deal with working with a gay person in his volunteer assignment. He responded that he would limit the interaction strictly to work issues. I thought that he would probably not be able to hide his bias. And here was this future volunteer, telling me, his trainer, that I was abnormal. I wasn’t hurt by this, but disappointed. How do you get someone like this to reconsider?

Weekend visits by the trainees to current volunteer sites were scheduled soon after this diversity session. Another trainee assigned to visit the gay volunteer who participated in the session expressed serious reservations about spending two nights in this volunteer’s house. Understandable, amusing, sad? Feeling that his fears were unfounded, I reassured him. He did go, and I heard no more about it.

During another diversity session, in another country, one of the trainees chose to excuse himself from a small group discussion about a hypothetical case study involving a non-gay volunteer who chose not to react to homophobic comments from a local counterpart, even though they weren’t directed at or about him. The volunteer, who said he found the attitudes expressed offensive, feared that if he spoke up in a situation like this, he could be perceived as being gay, and was concerned how that could affect his relationship with his workmates. I encouraged the trainee to express his views regarding the case study. During the report-back to the whole group, he explained his inability to discuss the case: “Look, I’m Catholic and the Pope says no to abortions and no to gays.” Both my co-facilitator and I were caught off guard. How could we respond to this? We all want to accept diversity of opinions, don’t we? What right does someone have to completely reject the very existence of someone else? We all have our own moral codes and standards. Who and what should we be required to accept, or in the absence of acceptance, respect as a right that someone else has? We simply acknowledged his different viewpoint without challenging it or exploring it further, afraid to open up a Pandora’s Box. This could have been a perfect opportunity to analyze what “celebrating diversity” really means. Instead of accepting the challenge, we left the issue unresolved with many in the group finding the trainee insensitive and closed-minded.

Even though I experienced many frustrations and uncertainties as a trainer, my overall experience has been that Peace Corps handles gay and lesbian issues progressively.

To make the Peace Corps a more gay friendly environment. I would like to see:

  • information about the gay and lesbian situation in the local country, and the support available to LGB volunteers provided shortly after volunteers arrive.
  • better diversity training for Peace Corps and training staff, which includes gay and lesbian concerns.
  • more discretion and sensitivity by everyone in the Peace Corps community about gay and lesbian issues.
  • more trainers, staff, and volunteers open about their sexuality, without being made to feel uncomfortable or threatened by this revelation.

Roy Schachter was a PCV in Honduras from 1983 to 1985. He served as a Peace Corps trainer in Latin America from 1993 to 1996.

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