Intersecting Stigma and the HIV Care Cascade: Qualitative Insights from Sex Workers, Men who have Sex with Men, and Transgender Women Living with HIV in Jamaica.

Journal: AIDS and behavior

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Affiliated Institutions:  Factor-Inwentash Faculty of Social Work, University of Toronto, Bloor Street W, Room , Toronto, ON, MS V, Canada. carmen.logie@utoronto.ca. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Faculty of Health Sciences, Western University, London, ON, Canada. Jamaica AIDS Support for Life (JASL), Kingston, Jamaica. Factor-Inwentash Faculty of Social Work, University of Toronto, Bloor Street W, Room , Toronto, ON, MS V, Canada. Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.

Abstract summary 

In Jamaica, stigma experiences of sex workers (SW), gay men and other men who have sex with men (MSM), and transgender women living with HIV remain understudied. To address this gap, we explored experiences of stigma and linkages with the HIV care cascade among key populations living with HIV in Jamaica, including cisgender women SW, MSM, and transgender women. This qualitative study involved n = 9 focus groups (FG), n = 1 FG per population living with HIV (SW, MSM, transgender women) in each of three sites (Kingston, St. Ann, Montego Bay). We also conducted key informant (KI) interviews. We applied thematic analysis informed by the Health Stigma and Discrimination (HSD) Framework. FG participants (n = 67) included SW (n = 18), MSM (n = 28), and trans women (n = 21); we interviewed n = 10 KI (n = 5 cisgender women, n = 5 cisgender men). Participant discussions revealed that stigma drivers included low HIV treatment literacy, notably misinformation about antiretroviral therapy (ART) benefits and HIV acquisition risks, and a lack of legal protection from discrimination. Stigma targets health (HIV) and intersecting social identities (sex work, LGBTQ identities, gender non-conformity, low socio-economic status). Stigma manifestations included enacted stigma in communities and families, and internalized stigma-including lateral violence. HIV care cascade impacts included reduced and/or delayed HIV care engagement and ART adherence challenges/disruptions. Participants discussed strategies to live positively with HIV, including ART adherence as stigma resistance; social support and solidarity; and accessing affirming institutional support. In addition to addressing intersecting stigma, future research and programing should bolster multi-level stigma-resistance strategies to live positively with HIV.

Authors & Co-authors:  Logie Carmen H CH Kinitz David J DJ Gittings Lesley L Lalor Patrick P MacKenzie Frannie F Newman Peter A PA Baral Stefan D SD Mbuagbaw Lawrence L Shuper Paul P Levermore Kandasi K

Study Outcome 

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Statistics
Citations :  Viswasam N, Schwartz S, Baral S. Characterizing the role of intersecting stigmas and sustained inequities in driving HIV syndemics across low-to-middle-income settings. Curr Opin HIV AIDS. 2020;15:243–9.
Authors :  10
Identifiers
Doi : 10.1007/s10461-024-04460-6
SSN : 1573-3254
Study Population
Men,Women
Mesh Terms
Other Terms
HIV;Jamaica;Men who have sex with men;Sex Workers;Stigma;Transgender
Study Design
Study Approach
Qualitative
Country of Study
Publication Country
United States