Logie Carmen H, Lacombe-Duncan Ashley, Brien Natasha, Jones Nicolette, Lee-Foon Nakia, Levermore Kandasi, Marshall Annecka, Nyblade Laura, Newman Peter A
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada.
J Int AIDS Soc. 2017 Apr 4;20(1):21385. doi: 10.7448/IAS.20.1.21385.
Young men who have sex with men (MSM) in Jamaica have the highest HIV prevalence in the Caribbean. There is little information about HIV among transgender women in Jamaica, who are also overrepresented in the Caribbean epidemic. HIV-related stigma is a barrier to HIV testing among Jamaica's general population, yet little is known of MSM and transgender women's HIV testing experiences in Jamaica. We explored perceived barriers and facilitators to HIV testing among young MSM and transgender women in Kingston, Jamaica.
We implemented a community-based research project in collaboration with HIV and lesbian, gay, bisexual and transgender (LGBT) agencies in Kingston. We held two focus groups, one with young (aged 18-30 years) transgender women (n = 8) and one with young MSM (n = 10). We conducted 53 in-depth individual semi-structured interviews focused on HIV testing experiences with young MSM (n = 20), transgender women (n = 20), and community-based key informants (n = 13). We conducted thematic analysis to identify, analyze, and report themes.
Participant narratives revealed social-ecological barriers and facilitators to HIV testing. Barriers included healthcare provider mistreatment, confidentiality breaches, and HIV-related stigma: these spanned interpersonal, community and structural levels. Healthcare provider discrimination and judgment in HIV testing provision presented barriers to accessing HIV services (e.g. treatment), and resulted in participants hiding their sexual orientation and/or gender identity. Confidentiality concerns included: clinic physical arrangements that segregated HIV testing from other health services, fear that healthcare providers would publicly disclose their status, and concerns at LGBT-friendly clinics that peers would discover they were getting tested. HIV-related stigma contributed to fear of testing HIV-positive; this intersected with the stigma of HIV as a "gay" disease. Participants also anticipated healthcare provider mistreatment if they tested HIV positive. Participants identified individual (belief in benefits of knowing one's HIV status), social (social support) and structural (accessible testing) factors that can increase HIV testing uptake.
Findings suggest the need for policy and practice changes to enhance confidentiality and reduce discrimination in Jamaica. Interventions to challenge HIV-related and LGBT stigma in community and healthcare settings can enhance access to the HIV prevention cascade among MSM and transgender youth in Jamaica.
牙买加与男性发生性关系的年轻男性（MSM）的艾滋病毒感染率在加勒比地区最高。关于牙买加跨性别女性中的艾滋病毒情况知之甚少，她们在加勒比地区的疫情中所占比例也过高。与艾滋病毒相关的耻辱感是牙买加普通人群进行艾滋病毒检测的障碍，但对于牙买加男男性行为者和跨性别女性的艾滋病毒检测经历却知之甚少。我们探讨了牙买加金斯敦年轻男男性行为者和跨性别女性在艾滋病毒检测方面所感知到的障碍和促进因素。
我们与金斯敦的艾滋病毒及女同性恋、男同性恋、双性恋和跨性别者（LGBT）机构合作开展了一项基于社区的研究项目。我们举办了两个焦点小组，一个由年轻（18至30岁）跨性别女性（n = 8）组成，另一个由年轻男男性行为者（n = 10）组成。我们针对年轻男男性行为者（n = 20）、跨性别女性（n = 20）和社区关键信息提供者（n = 13）进行了53次深入的个人半结构化访谈，重点是艾滋病毒检测经历。我们进行了主题分析，以识别、分析和报告主题。
参与者的叙述揭示了艾滋病毒检测的社会生态障碍和促进因素。障碍包括医疗服务提供者的不当对待、保密措施的泄露以及与艾滋病毒相关的耻辱感：这些跨越了人际、社区和结构层面。医疗服务提供者在提供艾滋病毒检测时的歧视和评判给获得艾滋病毒服务（如治疗）带来了障碍，并导致参与者隐瞒自己的性取向和/或性别认同。对保密的担忧包括：诊所的物理布局将艾滋病毒检测与其他医疗服务隔离开来，担心医疗服务提供者会公开披露他们的状况，以及在对LGBT友好的诊所担心同伴会发现他们在接受检测。与艾滋病毒相关的耻辱感加剧了对检测出艾滋病毒呈阳性的恐惧；这与将艾滋病毒视为“同性恋”疾病的耻辱感相互交织。参与者还预计如果检测出艾滋病毒呈阳性会受到医疗服务提供者的不当对待。参与者确定了可以增加艾滋病毒检测接受度的个人（相信了解自己艾滋病毒状况的益处）、社会（社会支持）和结构（可获得检测）因素。
研究结果表明，牙买加需要在政策和实践方面做出改变，以加强保密性并减少歧视。在社区和医疗环境中挑战与艾滋病毒相关及LGBT耻辱感的干预措施，可以增加牙买加男男性行为者和跨性别青年获得艾滋病毒预防措施的机会。
