Barriers and facilitators to participation of men who have sex with men and transgender women in HIV research in Jamaica.

To assess potential barriers and facilitators to participation in bio-behavioural surveillance surveys of men who have sex with men and transgender women (trans women) in Jamaica, we recruited participants for individual interviews and focus group discussions. Respondents included 3 trans women; 46 gay, bisexual and other men who have sex with men; and 3 cis gender women. Data from 46 men and 3 trans women were analysed to describe barriers and facilitators to participation in research. Barriers identified were: lack of perceived benefits from research participation due to high socioeconomic status; concerns about confidentiality and unintended disclosure; HIV fatigue and fear of knowing one's HIV status; distrustful inter-group dynamics; and undesirable study location and hours. Facilitators to participation in research were: belonging to a marginalised subgroup of men who have sex with men or trans women; incentives; and trust in researchers and community input in planning the study. Findings emphasise the need to understand the individual, interpersonal and structural factors that shape relationships, disclosure and interactions to successfully enrol diverse samples of men who have sex with men and trans women.

Beyond Homophobia: How Do Jamaican Men Who Have Sex with Men Build Communities, Affirm Identity, and Mitigate Homophobia?

Jamaican men who have sex with men (MSM) have experienced widespread stigma and discrimination. Much of the research on Jamaican MSM has focused on HIV risk behaviors. We examined the social and romantic relationships of Jamaican MSM and how these factors fostered a sense of community in an antihomosexual environment. Qualitative in-depth interviews were conducted with 30 MSM ages 18 to 29 years. Women and familial matriarchal figures were more likely to accept someone identified as homosexual and provide protection against homophobia. Jamaican MSM affirmed their identity by providing emotional support and safe spaces, which aided in building a sense of community. Relationships with friends and intimate partners were a source of love and validation as opposed to simply sexual gratification. The social and romantic relationships of Jamaican MSM transcended the social boundaries of homophobia, affirmed sexual identity and orientation, and served as facilitators across most general societal and cultural interactions.

HIV Risk and Gender in Jamaica's Homeless Population.

Rigorous HIV-related data for the homeless population in Jamaica is limited. A cross-sectional survey using a venue-based sampling approach was conducted in 2015 to derive HIV prevalence and associated risk factors. Three hundred twenty-three homeless persons from the parishes of St. James, St. Ann, Kingston, and St. Andrew (the main urban centers) participated. HIV prevalence was 13.8%, with a difference in gender (males 11.6%, females 26.7%, P = .007). Sex work, multiple partnerships, incarceration, non-injecting drug use, and female rape were common among the participants. Long-term, multilayered, HIV-specific, female-focused interventions are required for the population, along with additional female-centric research.

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults.

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15-24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.

High prevalence of psychiatric and substance use disorders among persons seeking treatment for HIV and other STIs in Jamaica: a short report.

This cross-sectional study explored the range of psychiatric and substance use disorders and unmet need for mental health care among 84 HIV-positive and 44 HIV-negative public clinic attendees in Jamaica. We used a brief interviewer-administered diagnostic tool, the Client Diagnostic Questionnaire. Two-thirds (65.6%) screened positive for at least one psychiatric disorder; 30.5% screened positive for multiple disorders. The most common disorders were post-traumatic stress disorder (PTSD) (41.4%), alcohol abuse (22.7%), and depressive disorders (21.9%). One in fourteen (7.1%) participants with at least one diagnosis received care in the last 6 months. Adjusting for age and sex, PTSD was associated with non-adherence to antiretroviral treatment (AOR = 5.32), anxiety disorders (AOR = 5.82), depression (AOR = 4.29), and suicidal ideation (AOR = 8.17). Psychiatric and substance use disorders, particularly PTSD, were common among STI/HIV clinic attendees in Jamaica. Such clinics may be efficient places to screen, identify, and treat patients with psychiatric disorders in low- and middle- income countries.

Contexts of risk and networks of protection: NYC West Indian immigrants' perceptions of migration and vulnerability to sexually transmitted diseases.

To generate insights into how migration shapes sexual risk and protection, we interviewed 36 female and 20 male West Indian immigrants attending a public sexually transmitted disease clinic in Brooklyn, New York, between 2004 and 2005. Migration theory suggests that shifts in sexual partnership patterns, bi-directional travel and changes in sexual norms may alter risk. We found evidence of sexual mixing across ethnic groups: a large proportion of participants' partners were not born in the West Indies, despite what is expected among first generation immigrants. Recent travel 'home', another potential source of risk, was uncommon. In open-ended interviews, two themes around sexual and social networks emerged. First, immigrants believed that access to wider, more anonymous sexual networks in New York City (NYC) and the weakening of social controls that limit multiple partnerships (especially for women) promoted greater risk. Second, immigrants experienced greater opportunities for protection in NYC, both through exposure to safer sex messages and availability of condoms. Reported changes in their own condom use, however, were not attributed to migration. West Indian immigrants' risk in NYC may be driven by access to wider sexual networks but failure to alter reliance on 'networks of knowledge' for protection.

Using estimation and projection package and Spectrum for Jamaica's national HIV estimates and targets.

BACKGROUND: Adequate coverage of target populations ensures that desired outcomes, such as increased survival of people living with HIV, are achieved. However, estimates of coverage and impact of HIV programmes using available data are limited by the complex natural history of HIV, underreporting of cases and inadequate information systems. METHODS: Jamaica's national HIV estimates were generated using the 2009 version of the UNAIDS estimation and projection package (EPP) and Spectrum. National data used included sentinel surveillance data on antenatal clinic attendees (1986-2005 and 2007), distribution of antiretroviral regimes for prevention of mother-to-child transmission, distribution of antiretroviral therapy (ART) among adults and ART distribution in subpopulations (e.g., men who have sex with men (MSM) and sex workers). Surveys of MSM (2007), sex worker (2001, 2005, 2008), STI clinic attendees (1990-2002) and inmates (2006) also provided inputs. RESULTS: In 2009, Jamaica's HIV prevalence was estimated at 1.7% (range 1.1-2.5) and 31 000 (range 20 000-43 000) adults (>15 years) were living with HIV. The number of adults in need of treatment was 15 000 (range 11 000-19 000) and approximately 2100 new infections occurred in 2009. The EPP/Spectrum estimates were generally consistent with locally available data. However, the number of persons with advanced HIV targeted by the national treatment programme was significantly lower than Spectrum's estimated target population. CONCLUSION: EPP/Spectrum can provide important data for national HIV programme planning. Improved monitoring and evaluation systems will provide quality data and result in more robust estimates.

HIV and sexually transmitted infection risk behaviors and beliefs among Black West Indian immigrants and US-born Blacks.

OBJECTIVES: We compared Black West Indian immigrants' and US-born Blacks' sexual and drug-use risk behaviors and their beliefs related to using condoms and informing partners of sexually transmitted infections (STIs) to identify possible differences in risk. METHODS: We drew data from the baseline assessment of a clinic-based intervention designed to increase partner STI notification. RESULTS: Black West Indian men were less likely than were US-born Black men to report nonregular partners. There were no differences in condom use. US-born Black women were more likely than were Black West Indian women to be extremely confident that they could convince their regular partners to use condoms (odds ratio [OR] = 2.40; 95% confidence interval [CI] = 1.21, 4.76), whereas there were no differences between Black West Indian and US-born Black men on this measure (interaction P = .06). US-born Black women were more likely than were Black West Indian women to be extremely confident in their ability to discuss STI screening with their regular partners (OR = 1.89; 95% CI = 1.03, 3.47). CONCLUSIONS: Black West Indian women's lower levels of confidence that they can discuss STI screening with their regular partners and convince these partners to use condoms may increase their infection risk. Gender-sensitive interventions are warranted for Black West Indian immigrants, especially women.