title: High HIV prevalence among men who have sex with men in Jamaica is associated with social vulnerability and other sexually transmitted infections.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) prevalence among men who have sex with men (MSM) is thought to be high in Jamaica. The objective of this study was to estimate HIV prevalence and identify risk factors in order to improve prevention approaches.
  
  
  METHODS
  With the help of influential MSM, an experienced research nurse approached MSM in four parishes to participate in a cross-sectional survey in 2007. Men who have sex with men were interviewed and blood taken for HIV and syphilis tests, and urine taken for gonorrhoea, chlamydia and trichomonas testing using transcription-mediated amplification assays. A structured questionnaire was administered by the nurse.
  
  
  RESULTS
  One third (65 of 201; 32%, 95% Confidence Interval (CI) 25.2, 47.9) of MSM were HIV positive. Prevalence of other sexually transmitted infections (STI) was: chlamydia 11%, syphilis 6%, gonorrhoea 3.5% and trichomonas 0%. One third (34%) of MSM identified themselves as being homosexual, 64% as bisexual and 1.5% as heterosexual. HIV positive MSM were significantly more likely to have ever been told by a doctor that they had an STI (48% vs 27%, OR 2.48 CI 1.21, 5.04, p = 0.01) and to be the receptive sexual partner at last sex (41% vs 23%, OR 2.41 CI 1.21, 4.71, p = 0.008). Men who have sex with men who were of low socio-economic status, ever homeless and victims of physical violence were twice as likely to be HIV positive. The majority (60%) of HIV positive MSM had not disclosed their status to their partner and over 50% were not comfortable disclosing their status to anyone.
  
  
  CONCLUSIONS
  The high HIV prevalence among MSM is an important factor driving the HIV epidemic in Jamaica. More effective ways need to be found to reduce the high prevalence of HIV among MSM including measures to reduce their social vulnerability, combat stigma and discrimination and empower them to practice safe sex.
authors.affiliation: Department of Community Health and Psychiatry, The University of the West Indies, Kingston 7, Jamaica. peter.figueroa10@gmail.com.
authors.forename: J P
authors.initials: JP
authors.lastname: Figueroa
authors.affiliation: University of North Carolina Chapel Hill, United States of America.
authors.forename: S S
authors.initials: SS
authors.lastname: Weir
authors.affiliation: Ministry of Health, Kingston, Jamaica.
authors.forename: C
authors.initials: C
authors.lastname: Jones-Cooper
authors.affiliation: Ministry of Health, Kingston, Jamaica.
authors.forename: L
authors.initials: L
authors.lastname: Byfield
authors.affiliation: University of North Carolina, Chapel Hill, United States of America.
authors.forename: M M
authors.initials: MM
authors.lastname: Hobbs
authors.affiliation: Jamaica AIDS Support for Life Kingston, Jamaica.
authors.forename: I
authors.initials: I
authors.lastname: McKnight
authors.affiliation: University of North Carolina, Chapel Hill, United States of America.
authors.forename: S
authors.initials: S
authors.lastname: Cummings
mesh_terms: D000328:Adult; D001727:Bisexuality / Q000706:statistics & numerical data*; D002690:Chlamydia Infections / Q000453:epidemiology; D019548:Crime Victims / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D013587:Syphilis / Q000453:epidemiology; D014245:Trichomonas Infections / Q000453:epidemiology; D047568:Unsafe Sex; D035862:Vulnerable Populations; D055815:Young Adult
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