Background
The epidemic in Jamaica has features of both a generalized and concentrated epidemic. As of December 2019, there were 32,617 persons or approximately 1.6% of the Jamaican adult population estimated to be infected with HIV. It is estimated that almost 16% of HIV infected persons are unaware of their status. High HIV prevalence has been recorded in vulnerable groups such as female sex workers (SW) (2%), MSM (29%), and persons with STIs (3.6%), homeless/drug users (5%), and prison inmates (6%). Sentinel surveillance of women attending antenatal clinics indicate that there is no significant change in the prevalence of HIV over the last decade despite prevention efforts. However, there has been a significant decline in AIDS Deaths and mother-to-child transmission of HIV, over the past decade.
Despite the stabilization of incidence seen in the ANC population, persistent behavioral, social and cultural factors continue to fuel the epidemic in high risk groups and high rates of transactional sex, and early age of sexual debut are important ingredients for further spread of HIV in the general population. Some of these behaviors are driven by increasing poverty, population dynamics, and well-established gender roles in which men are sexual decision makers.
There is an urgent need in Jamaica to increase the effectiveness of prevention programs among high risk groups to limit the spread of HIV. This requires a multi-faceted approach including school-based programs, mass media campaigns and targeted approaches for those most at risk for contracting HIV. The prevention response needs strategic information in order to improve programs aimed at preventing increased incidence of HIV. This includes information about the prevalence of HIV and other STIs as well as information about the characteristics and behaviors of key populations.
PLACE surveys among female sex workers was first implemented in Jamaica in 2002; however, it was in 2011 that for the first time they were implemented on a national scale. This survey was repeated in 2014 when over 1200 sites and events where people meet new sexual partners were identified. 485 sites with sex work and a random sample of other identified sites were visited by the NFPB HIV Outreach team. Proximate determinants of the heterosexual epidemic identified among female venue workers, female sex workers, female patrons of venues were high numbers of sexual partners, lack of condom use and untreated STI.
The most recent FSW survey was conducted in 2017. The findings indicated that there was a continuous decline in HIV prevalence among sex workers that self-identified to 2%. Of note is a shift in the epidemic, with greater HIV numbers among those who operated in enclosed venues compared to FSW who worked on the street. Another noteworthy shift was the higher numbers of positive cases among the younger age cohorts compared to the older groups. Neither of these features have been observed before and this warrants further investigation and monitoring. The staff at sex work venues continue to be a high risk group with an HIV prevalence of 3%.