title: Understanding the high prevalence of HIV and other sexually transmitted infections among socio-economically vulnerable men who have sex with men in Jamaica.
abstract: OBJECTIVE
  This study estimates HIV prevalence among men who have sex with men (MSM) in Jamaica and explores social determinants of HIV infection among MSM.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Community Health and Psychiatry, University of West Indies, Mona, Kingston 7, Jamaica.
authors: J Peter
authors: JP
authors: Figueroa
authors: Epidemiology and Research Training Unit, Kingston, Jamaica.
authors: Carol Jones
authors: CJ
authors: Cooper
authors: Carolina Population Center and Department of Epidemiology, University of North Carolina, Chapel Hill, United States of America.
authors: Jessie K
authors: JK
authors: Edwards
authors: Department of Community Health and Psychiatry, University of West Indies, Mona, Kingston 7, Jamaica.
authors: Lovette
authors: L
authors: Byfield
authors: Comprehensive Health Centre, Kingston, Jamaica.
authors: Shashauna
authors: S
authors: Eastman
authors: Departments of Medicine and Microbiology & Immunology, University of North Carolina, Chapel Hill, United States of America.
authors: Marcia M
authors: MM
authors: Hobbs
authors: Carolina Population Center and Department of Epidemiology, University of North Carolina, Chapel Hill, United States of America.
authors: Sharon S
authors: SS
authors: Weir
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012959:Socioeconomic Factors