Research Article: Understanding the High Prevalence of HIV and Other Sexually Transmitted Infections among Socio-Economically Vulnerable Men Who Have Sex with Men in Jamaica

Date Published: February 6, 2015

Publisher: Public Library of Science

Author(s): J. Peter Figueroa, Carol Jones Cooper, Jessie K. Edwards, Lovette Byfield, Shashauna Eastman, Marcia M. Hobbs, Sharon S. Weir, Joan A Caylà.

http://doi.org/10.1371/journal.pone.0117686

Abstract

This study estimates HIV prevalence among men who have sex with men (MSM) in Jamaica and explores social determinants of HIV infection among MSM.

An island-wide cross-sectional survey of MSM recruited by peer referral and outreach was conducted in 2011. A structured questionnaire was administered and HIV/STI tests done. We compared three groups: MSM who accepted cash for sex within the past 3 months (MSM SW), MSM who did not accept cash for sex (MSM non-SW), and MSM with adverse life events (ever raped, jailed, homeless, victim of violence or low literacy).

HIV prevalence among 449 MSM was 31.4%, MSM SW 41.1%, MSM with adverse life events 38.5%, 17 transgender MSM (52.9%), and MSM non-SW without adverse events 21.0%. HIV prevalence increased with age and number of adverse life events (test for trend P < 0.001), as did STI prevalence (P = 0.03). HIV incidence was 6.7 cases/100 person-years (95% CI: 3.74, 12.19). HIV prevalence was highest among MSM reporting high-risk sex; MSM SW who had been raped (65.0%), had a STI (61.2%) and who self identified as female (55.6%). Significant risk factors for HIV infection common to all 3 subgroups were participation in both receptive and insertive anal intercourse, high-risk sex, and history of a STI. Perception of no or little risk, always using a condom, and being bisexual were protective. HIV prevalence was high among MSM SW and MSM with adverse life events. Given the characteristics of the sample, HIV prevalence among MSM in Jamaica is probably in the range of 20%. The study illustrates the importance of social vulnerability in driving the HIV epidemic. Programs to empower young MSM, reduce social vulnerability and other structural barriers including stigma and discrimination against MSM are critical to reduce HIV transmission.

Partial Text

Men who have sex with men (MSM) have high HIV disease burden worldwide [1]. Even in high-income countries where overall HIV epidemic trends are in decline, HIV prevalence remains high among MSM [2]. This is attributed to high per-act and per-partner HIV transmission probability of unprotected receptive anal intercourse and casual partnerships [3]. Structural issues and cultural norms such as poverty, access to services, stigma, discrimination, homophobia, gender roles and sexual identity contribute to greater vulnerability to HIV infection [4]. Social structural barriers and sexual network and partnership patterns contribute to higher HIV disease burden among black MSM in high-income countries despite black MSM reporting fewer sexual risk behaviours than other MSM [5]. Prevention efforts have had limited success in curbing HIV among MSM [6].

An island-wide survey of MSM was conducted in Jamaica in 2011. MSM were recruited by peer referral and targeted outreach. Respondents had to be age 16 or older, self identify as MSM, complete the interview, provide blood and urine for HIV/STI tests and sign informed consent. There was no financial incentive given to participate in the study. The Ministry of Health Ethics and Medico-Legal Advisory Panel approved the study and the informed consent process. Written informed consent was obtained from participants including those aged 16 years of age which is the legal age of consent in Jamaica.

A total of 449 MSM completed interviews and blood tests. The refusal rate was 4.2%. Participants were enrolled through behaviour change workshops (145 or 32.3%), verbal referral by participants (109 or 24.3%) the study coordinator’s MSM contacts (77 or 17.1%), use of referral cards from participants (46 or 10.2%), interviewers at social events and parks (43 or 9.6%) and through a NGO service point (29 or 6.5%). Subject characteristics were generally similar among the MSM according to recruitment method.

The HIV prevalence of 31.4% among MSM in this survey was high and similar to previous surveys [7, 8]. However, the results cannot be generalised to MSM in Jamaica because the survey was not representative. Many participants were MSM sex workers, of low socio-economic status and/or socially vulnerable. HIV prevalence was very high among MSM SW (41.1%), those with adverse life events or low literacy (38.5%), and transgender MSM (52.9%). In contrast, HIV prevalence was 21.0% among MSM non-SW who had no adverse life events. Based on the findings and characteristics of the sample, we assess that HIV prevalence among MSM in Jamaica may be in the range of 20%, but unlikely to be lower than 15%.

 

Source:

http://doi.org/10.1371/journal.pone.0117686