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

• Published in: AIDS and behavior 2024-11, Vol.28 (11), p.3768-3786
• Main Authors: Logie, Carmen H., Kinitz, David J., Gittings, Lesley, Lalor, Patrick, MacKenzie, Frannie, Newman, Peter A., Baral, Stefan D., Mbuagbaw, Lawrence, Shuper, Paul, Levermore, Kandasi
• Format: Article
• Language: English
• Subjects: Adult; Antiretroviral agents; Antiretroviral therapy; Cisgender; Conformity; Discrimination; Female; Focus Groups; Gays & lesbians; Gender; Gender nonconforming; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - psychology; Homosexuality, Male - psychology; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; Infectious Diseases; Interviews as Topic; Jamaica - epidemiology; LGBTQ people; Male; Medical treatment; Medicine; Medicine & Public Health; Men; Men who have sex with men; Mens health; Middle Aged; Original Paper; Prostitution; Public Health; Qualitative Research; Resistance; Sex industry; Sex workers; Sex Workers - psychology; Sexual and Gender Minorities - psychology; Sexually transmitted diseases; Social interactions; Social Stigma; Social support; Socioeconomic status; Socioeconomics; STD; Stigma; Transgender persons; Transgender Persons - psychology; Transgender Persons - statistics & numerical data; Women; Young Adult
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-024-04460-6

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.