Attitudes towards homosexuals in seven Caribbean countries: implications for an effective HIV response

Abstract

Between 2000 and 2015, the number of people newly infected with HIV in the Caribbean decreased by 76% and HIV-related deaths by 42%. The number of people living with HIV (PLHIV) on anti-retroviral therapy (ART) increased from near zero to 50% (44% to 57%) in 2015. In many Caribbean countries communities of men-who-have-sex-with-other-men (MSM) have higher incidence and prevalence of HIV. They are often stigmatized and subjected to both social and institutional discrimination. This study compared attitudes of the general public obtained through public opinion polls 2013-2014 towards homosexuals and willingness to socialize with them in seven Caribbean countries. Informants were asked if they "hate, tolerate or accept" homosexuals and if they would socialize with them. In St. Vincent 53% indicated they "hate" homosexuals, compared with 12% in Suriname; the converse was observed for those who "accept" homosexuals; 63% of St. Vincent informants would not socialize with homosexuals, compared with 25% in Suriname. Findings for the other 5 countries fell within these ranges. Women were more likely to accept and socialize with homosexuals, as were informants with a tertiary education and "passive" religious believers. These groups are less likely to adhere to a culture of "compulsory heterosexuality" or "hyper-masculinity" dominant among Caribbean men. The homophobic views expressed by these cultures result in stigma and discrimination by members of the "general" public towards MSM. This negatively affects the involvement of MSM in successful national HIV responses. Public messaging, communications campaigns and educational measures need to be employed to change the culture of "compulsory heterosexuality" or "hyper-masculinity" that result in stigma and discrimination of homosexuals to improve early access to services by MSM. Repeat use of well performed opinion polls is one method that can be employed to monitor progress over time in "key" and "general" populations.

Global and regional trends of people living with HIV aged 50 and over: Estimates and projections for 2000–2020

“…PLHIV and other key population groups are marginalized, stigmatized and discriminated against, and face a range of health and social challenges [52,53]. PLHIV50+ are more likely to be single, live alone, have fewer friends and lack adequate social support networks compared to younger PLHIV [54,55].…”

Barriers and facilitators to past six-month HIV testing among men who have sex with men in Belize

“…Men were not only more likely to express hate toward homosexuals, but also were less likely to socialize with homosexuals, even when they tolerated or accepted homosexuals. 29 Because such discrimination and stigma can in turn lead to depression and shame, 30 interventions designed to address homophobia and normalize the lives and relationships of MSM in Belize are likely needed to increase the prevalence of past six-month HIV testing. 31 Along these lines, given the negative association of healthcare maltreatment with past six-month HIV testing, providing cultural competency trainings designed to increase understanding of the lived experiences of MSM in Belize could possibly increase the prevalence of past six-month HIV testing.…”

Gaps and opportunities: measuring the key population cascade through surveys and services to guide the HIV response

“…In addition, key population programme data only describe those key population members who access services at key population‐friendly facilities that disaggregate data by population rather than all key population members living with HIV (KPLHIV) who access services, leaving an incomplete picture of KPLHIV who access services. Stigma continues to hinder uptake of services by key populations and disclosure of key population practices and identities among those who do access them, resulting in low programme coverage and consequently, inadequate data for drawing conclusions about the population . And in some countries, the provision of services to key populations has been barred, effectively excluding the possibility of using programme data to inform cascades .…”