The Quiet Men: AI, Movember, and Caribbean Masculinity

Note from the President

The Charter is now in force in all fifteen CARICOM member states, after Saint Vincent and the Grenadines and Saint Kitts and Nevis completed their adoption process last week. We are now a region with a common AI policy floor for the first time. The work of implementation, in each country, will occupy the better part of the next two years. I will write about that in the December issue.

November is Diabetes Awareness Month, and it is Movember. Both observances sit on the same uncomfortable shelf, which is the shelf of conditions that disproportionately kill Caribbean men and that Caribbean men, on aggregate, are least willing to talk about. There is a piece I have wanted to commission on this subject since we started the newsletter, and Hector Ramirez-Diaz has finally written it. The piece is harder reading than usual, and I think it earns the difficulty.

A short note. Anthropic released its Claude Opus 4.5 model last week. For most members, again, the practical implication is small. For engineering teams running long context document workflows, the new model is worth evaluating. Several of our Founders Cohort companies are already migrating.

Adrian Dunkley Founder and President, Caribbean AI Association

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Feature

The Quiet Men: AI, Movember, and Caribbean Masculinity

By Hector Ramirez-Diaz

In the village I grew up in, on the south coast of Cuba, there was a man called Pancho, who repaired bicycles for forty years from the same wooden stall, and who had not in living memory been to a doctor. When he died, suddenly, of an undiagnosed cardiovascular condition at the age of sixty-three, the women of the village said what the women of every Caribbean village say. They said, that man was a stubborn one. They said it with the affection that the Caribbean reserves for its difficult dead. They also said it with an exhaustion that I did not understand until much later.

I am thinking about Pancho this Movember. The conditions whose names define this month, prostate cancer, testicular cancer, men's mental health, suicide in men, are conditions whose Caribbean numbers are bad, and whose Caribbean numbers are bad in part because Caribbean men, for reasons that are cultural and historical and stubbornly persistent, do not seek care until the option of seeking it has run out. We will be introducing, in the coming years, AI tools intended to support men's health. The question I want to raise in this column is whether those tools, as currently designed, will help or whether they will, in a way that is gentler but no less real, do what previous public health interventions have done, which is to fail to meet our men where they are.

Let me start with the data, because the data are the floor and not the conversation.

Prostate cancer in the Caribbean is, on the available regional registries, the most diagnosed cancer in men, and our age-standardized mortality rates are among the highest in the world. The age-standardized mortality rate for prostate cancer in Trinidad and Tobago, in the most recent figures published by the IARC, is roughly twice the rate in the United States and three times the rate in much of continental Europe. The reasons are not mysterious. Late presentation, limited access to specialist urology, gaps in the screening pathway, and the under-utilization of treatment options available in the public system. The numbers for Caribbean men of African descent in particular are worse than for the general population, and have been worse for as long as the registries have measured them.

Suicide rates in men across the Caribbean are, similarly, high. Guyana has had the highest male suicide rate in the world for most of the last decade. Trinidad's and Suriname's rates have sat well above the global average. The reasons here are more contested, but the pattern is consistent. The men in our region kill themselves at rates that should be a public emergency, and the men in our region remain, in survey after survey, the least likely group to seek mental health support before a crisis.

Cardiovascular disease is the largest single cause of premature death for Caribbean men, and the conditions that drive it, hypertension, diabetes, obesity, dyslipidemia, are conditions whose management depends on consistent engagement with primary care over decades. The men in our region engage with primary care less consistently than the women, by a substantial margin.

These are the conditions into which AI tools are now being introduced. The question for this column is whether the tools, in their current and emerging design, will help to close these gaps, or whether they will widen them in a way we will not see until it is too late to easily reverse.

I want to be specific about a concern.

The AI products being designed for health adherence, for chronic disease management, for mental health screening, and for primary care augmentation are being designed predominantly outside our region, by teams whose model of the patient is, in nearly every case, a patient who participates in their own care. The models assume a user who is willing to log into an app, to answer questions about their symptoms, to wear a continuous monitor, to take their medication on a schedule, to engage with reminders, to escalate when symptoms worsen, to do the work of being a patient. This is a reasonable user model for a large segment of the population. It is not a good user model for the Caribbean man who has not been to a clinic in seven years and who tells his wife, when she presses him, that he is fine.

The risk is not that the AI tools will harm men actively. The risk is that the AI tools will work well for the men who were already inclined to seek care, and will fail to reach the men who were not, and the gap between the two groups will widen rather than close. The men who are not in the system today will continue, in 2030, to not be in the system, and their conditions will continue to present late, and their outcomes will continue to be the outcomes they have been for a generation.

There is a deeper version of this question that I have been worrying at, and that I want to put before you, because I think it is the question the Association will eventually have to take a position on.

The question is whether the technology, in its current form, has anything to say to a particular kind of Caribbean masculinity, or whether it is essentially silent in front of it.

The masculinity I am describing is not the cartoon version that international media has at times made of our region. It is the masculinity of the fisherman in San Pedro, of the bus driver in Spanish Town, of the small farmer in the hills above Kingstown, of the retired tradesman in San Fernando, of my own grandfather in the village I have not visited in fifteen years. It is a masculinity built on competence, on provision, on the quiet discipline of not asking for help that you have learned, by hard experience, not to expect. It is a masculinity that is not unique to the Caribbean. It is also not absent in our region, and any honest public health practitioner in our region knows the texture of it intimately.

What does the AI in healthcare, as currently designed, have to say to that man.

The honest answer is that the AI in healthcare, as currently designed, mostly does not address itself to him. The user interfaces are designed for the people who download apps. The notification systems are designed for the people who want notifications. The conversational tone is designed for a user model that is, broadly, female, broadly younger than the man I am describing, and broadly more comfortable with the medical system as a place of help rather than a place of shame.

This is not a failing of any one product. It is a structural feature of how consumer health technology is built, by whom, and for whom. The Caribbean has, in this respect, the same problem the rural United States has, and the same problem Eastern European post-industrial cities have. The men who most need to be reached are the men least addressed by the current generation of tools.

So what should we do.

I will offer three thoughts. I will be honest that I am not sure any of them is sufficient.

The first thought is that the AI tools that succeed in reaching Caribbean men, in the next decade, will not be the consumer applications that look like the ones that are succeeding in other markets. They will be embedded in the institutions and relationships that Caribbean men already trust. The fishing cooperative. The taxi association. The masonic lodge. The football club. The Pentecostal church. The barbershop. The interaction with the AI will, in the working design, not feel to the user like an interaction with an AI. It will feel like a conversation with the cooperative officer who is using a new tool to help his members manage their pressure. The technology will be invisible. The trust will be the trusted person.

This is harder than building an app. It is also, on the evidence I have, the only design pattern that has, historically, succeeded with this population. CAIRA's Health Working Group is, in the coming year, supporting a small number of pilots along these lines, in partnership with regional community institutions. The point is to demonstrate the model and to publish what is learned.

The second thought is that the language of these tools, when they do speak, has to be the language of the men in question, not the language of public health professionals. The masculinity I have been describing has its own vocabulary, its own humour, its own indirection. The AI tools that have been built so far speak the language of the well-intentioned health pamphlet, which is a language Caribbean men have spent a lifetime ignoring. The work of building tools that speak, instead, in the actual cadences and concerns of the men we want to reach is, in a sense, a work of linguistic and cultural translation. The Caribbean men I have asked about this, when I have asked them, have been clear. They will not be talked at. They will, in some circumstances, accept being talked with. The difference is small in the writing and large in the design.

The third thought is the difficult one. The structural conditions that produce the Caribbean masculinity I have been describing, the histories of labour, of migration, of family arrangement, of religious teaching, of public schooling, of the legacies of slavery and colonialism, are conditions that no consumer health technology will resolve. The Caribbean men we are losing to prostate cancer, to cardiovascular disease, to suicide, are men we are losing because of an inheritance that is deeper than any application. The AI tools are part of the response. They cannot be the whole response. The response also needs, in our region, to include the slow cultural work of making it possible for a Caribbean man to ask for help without feeling, in some part of himself, that he has failed.

That work is being done, in small ways, by every Caribbean grandmother who has ever sat across the table from a stubborn son and told him to go and see the doctor. It is being done by every barber who has noticed a customer's silence and asked, gently, what is going on. It is being done by every football coach who has known, before any clinician, that one of his players was in trouble. The AI tools, if they are designed with care and humility, can support these people. They cannot replace them.

I think of Pancho, sometimes, and I wonder if there is a tool, somewhere in the next ten years, that would have reached him. I am not sure. He was a man who did not trust new things, and the country he lived in did not have, in his time, the basics of cardiovascular care that would have given a tool, of any kind, something to work with. What I do know is that the women who buried him, when they spoke of him after, did not say he should have downloaded an app. They said he should have, at some point, let someone in. The AI tools that succeed with men like Pancho will be the ones that find a way to be let in.

A quiet Movember to the men reading this. If there is something you have been not saying for a long time, this is the month to say it.

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Hector Ramirez-Diaz writes on Caribbean philosophy, technology, and cultural studies. He is a visiting lecturer at the University of Havana and serves on the CAIRA Editorial Board.

Originally published in The Monthly Intelligence Report, November 2025.