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. Almost 16% of HIV infected persons are unaware of their status. Higher HIV prevalence has been recorded in vulnerable groups such as female sex workers (SW) (2%), men who have sex with Men (MSM) (29%), persons with STIs (3.6%), homeless/drug users (13%), and prison inmates (7%).
There is an urgent need in Jamaica to increase the effectiveness of prevention programs among high-risk groups to limit the spread of HIV. Many approaches are needed to contain the epidemic, including school-based programs, mass media campaigns and targeted approaches for those most at risk. The prevention response needs strategic information in order to improve programs. This includes information about the prevalence of HIV and other STI. It also includes information about the characteristics and behaviours of key populations.
According to UNAIDS 2019, HIV prevalence among MSM in the Caribbean ranges between 1.1% in Cuba to 29.6% in Jamaica, which reflects the increasingly serious nature of the epidemic in the region. Two territories in the region – Jamaica, Trinidad and Tobago have prevalence higher than 20% among MSM. The stigma associated with homosexuality continues to be widespread (Figueroa et al. 2017, 876 study, 2018). The risk of hostility, verbal abuse, aggression and physical violence is real for MSM and transgender persons. Religious beliefs are used to rationalize and justify the negative attitudes towards MSM and contribute to the animosity that sometimes fuels aggression and violence against MSM (Reference). Most Jamaicans do not understand issues of sexual and gender identities and the challenges faced by transgender persons who have their own special needs (Reference).
The anti-buggery law is also an ongoing reminder to MSM societal rejection and criminalization of their sexual orientation. The rejection often induces shame, conflict, low self-esteem and risk-taking. MSM of lower socioeconomic status are more vulnerable, and boys may be chased from their homes and become homeless and subject to sexual abuse or transactional sex or forced into commercial sex. MSM who are of low literacy or experience adverse life events such as violence, jail or homelessness is at significantly higher risk of HIV (Figueroa et al. 2015). Some MSM are forced to disguise their sexuality and as such, have relationships with women or marry to pretend to be straight. Some men are fearful of doing an HIV test.
Bio-behavioural Surveillance Studies (BBSS) among MSM have been implemented in Jamaica for over 10 years (every 4 years). The results are used to develop programs to reduce the prevalence among the populations. The 2011 study showed a prevalence of 31.7% (Figueroa et al. 2011). Subgroup analysis of this study revealed an HIV prevalence of 45% among 95 respondents who identified as female (but did not self-identify as transgender), and 52.9% among 17 respondents who self-identified as transgender women (TGW). The latest study conducted in 2017/2018 showed a prevalence of 29.6% among MSM and 51% among transgender women.
Another study is due in 2021 and will establish HIV prevalence among MSM and transgender persons and collect information that will guide and improve HIV/STIs interventions among the population at risk.