Page 56 - Demo

Understanding the high prevalence of HIV and other sexually transmitted infections among socioeconomically vulnerable men who have sex with men in Jamaica
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Results
A total of 449 MSM completed the survey and 19 men refused to participate. Most (75%) MSM described their gender as male, 21% as female and 4% as transgender.The majority were bisexual (57%), 16 – 24 years of age (62%), of low socioeconomic status (72%), unemployed (57%), and had not completed secondary school (73%). Most (77%) were not comfortable telling others that they were MSM. The majority (57%) had either been raped, jailed, homeless, a victim of violence and/or low literacy. One fifth (21%) of MSM reported accepting cash for sex in the prior three months, while 36% had received or given gifts or goods for sex, but not cash. Nearly one third had met a new sex partner on the street (29%) or on the Internet (31%). Most (79%) MSM have had an HIV test. A minority (15%) knew the HIV status of their main male partner, and had disclosed their own status.
HIV prevalence among the 449 MSM was 31%. HIV prevalence was higher among MSM sex workers - 41%, MSM with adverse life events - 38%, and 17 transgender MSM - 53%. Those MSM who were not sex workers and had no adverse life events had a relatively lower HIV prevalence - 21%. Both HIV and STI prevalence increased significantly with age and the number of adverse life events. On average, nearly 7% of young MSM become newly HIV infected every year.
HIV prevalence was highest among MSM sex workers who had been raped (65%), had an STI (61%) and who self-identified as female (56%). Significant risk factors for HIV infection common to all three subgroups of MSM were participation in both receptive and insertive anal intercourse, high-risk sex, and history of an STI. MSM who always used a condom or were bisexual were less likely to be HIV positive.
Discussion
This study brings new insight into the factors contributing to the high HIV prevalence among MSM in Jamaica and many other countries. The researchers analysed MSM sex workers separately from other MSM because sex for cash significantly increases the risk of HIV infection. Many surveys of MSM fail to take this into account.
A highly significant association was found between HIV infection and the number of adverse life events experienced by MSM, including ever being raped, homeless, jailed, subject to violence, or of low literacy. The researchers are not aware of this finding being reported before. The study illustrates the importance of social vulnerability in driving the HIV epidemic among MSM.
The findings of this study clearly indicate that in order to control the HIV epidemic among MSM in Jamaica there must be significant social and cultural changes. Criminalising and stigmatising MSM promotes discrimination against them and contributes to the high prevalence of HIV infection. It erodes their self-esteem, which is critical for practicing safe sex. It also drives them underground and makes them fearful to disclose their HIV status to their sexual partners, and reduces their access to HIV prevention and treatment services. As many as seven percent (7%) of new HIV infections in Jamaica are among female partners of men who have sex with both men and women.
Conclusion
HIV prevalence was very high among MSM sex workers (41%) and MSM with adverse life events (38%); and high (21%) among MSM who were not sex workers and had no adverse life events. The study illustrates the importance of social vulnerability and stigma in driving the HIV epidemic among MSM. Programmes are needed to empower young MSM and reduce their social vulnerability. Reducing the structural barriers facing MSM, including stigma and discrimination, and repealing the Buggery Act, is critical to reducing HIV transmission in Jamaica.
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Recognising Outstanding Researchers 2016
Recognising Outstanding Researchers 2016