High HIV Prevalence among Men Who Have Sex with Men in Jamaica is Associated with Social Vulnerability and Other Sexually Transmitted Infections

Abstract

Background HIV prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches. Methods With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. MSM were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, Chlamydia and Trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse. Results One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2% – 47.9%) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: Chlamydia 11%, syphilis 6%, gonorrhea 3.5% and Trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had a STI (48% vs. 27%, OR 2.48 CI 1.21 – 5.04, p=0.01) and to be the receptive sexual partner at last sex (41% vs. 23%, OR 2.41 CI 1.21 – 4.71, p=0.008). MSM who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone. Conclusions The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.

Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey

“…Approximately one-third of participants reported selling sex in the past 12 months. While higher than some other global contexts [4,20,24], this prevalence is similar to prior studies with MSM in Jamaica [2,12]. Our finding that selling sex was not associated with differences in HIV serostatus corroborates findings from a 2011 study with MSM in Jamaica [2], yet contrasts with other global studies [2,26–32].…”

“…MSM are a key population in the global HIV pandemic [8,9], including in Caribbean and Latin American countries [10–12]. In Jamaica, MSM remain at elevated risk for HIV acquisition with a reported HIV prevalence between 28% and 32% [2,12] in comparison with a general population prevalence of 1.7% (95% CI: 1.4–2.0) among reproductive aged adults [13,14]. This prevalence is among the highest in the Caribbean [2,15], and is shaped, in part, by the criminalization of same-sex sexual behaviors.…”

“…The prevalence of selling sex among MSM varies across contexts, in part due to methodological challenges in sampling a marginalized, and often criminalized, population [1,2,4,12,20–23]. Among MSM (n = 24,051) in 17 Latin American countries, 7.2% reported transactional sex [24].…”

“…One-quarter of MSM in Brazil (n = 658) recruited via respondent-driven sampling reported ever receiving payment for sex [4]. In Jamaica, cross-sectional surveys conducted with MSM in 2007 (n = 201) [12] and 2011 (n = 449) [2] identified the prevalence of sex-selling as 35.9% overall [2], and 30.5% and 39.4% among HIV negative and positive persons, respectively [12]. In contexts with pervasive sexual stigma and discrimination, MSM may experience limited access to education and employment, and may lose familial support; this may contribute to poverty, homelessness, and engagement in survival sex work for money in addition to food, rent, shelter, drugs, and/or alcohol [5,6,20,25].…”

“…Two prior studies in Jamaica examining sex-selling among MSM have reported different findings regarding sex work and HIV infection risks. A 2007 study found that HIV prevalence did not differ based on sex work involvement [12], whereas a 2011 study reported higher HIV prevalence among MSM involved in sex work (41.1%) compared to other participants (21.0%) [2]. This study [2] used bivariate analyses to identify structural factors associated with ever being paid for sex among MSM, including homelessness and unemployment.…”