Factors associated with sexually transmissible infection testing practices among men who have sex with men in Jamaica: results from a cross-sectional, tablet-based survey
Carmen H. Logie A B F , Kathleen S. Kenny C , Ashley Lacombe-Duncan A , Ying Wang A , Kandasi Levermore D , Nicolette Jones D , Tyrone Ellis D and Annecka Marshall E
+ Author Affiliations
- Author Affiliations
A Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Canada. M5S 1V4
B Women’s College Research Institute, Women’s College Hospital, 76 Grenville Street, Toronto, Canada. M5S 1B2
C Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, North Carolina, 27599, USA.
D Jamaica AIDS Support for Life, 3 Hendon Drive, Kingston 20, Jamaica.
E Institute for Gender and Development Studies, University of the West Indies, Mona Campus, Kingston 7, Jamaica.
F Corresponding author. Email: carmen.logie@utoronto.ca
Sexual Health 15(4) 325-334 https://doi.org/10.1071/SH17186
Submitted: 4 October 2017 Accepted: 20 March 2018 Published: 21 June 2018
Abstract
Background: Men who have sex with men (MSM) are at elevated risk for sexually transmissible infection (STI) acquisition globally. Yet, limited research has explored STI testing practices among MSM in contexts where same-sex practices are criminalised, such as in Jamaica. Methods: A cross-sectional, tablet-based survey with MSM in Kingston, Ocho Rios and Montego Bay, Jamaica, was conducted. Multivariable logistic regression analyses were conducted to determine the adjusted risk ratio for lifetime STI testing and lifetime STI diagnosis. Multinomial logistic regression analyses were conducted to determine the relative odds of having had an STI test 3–5 months ago and 6–12 months ago in comparison with <3 months ago. Results: Three-quarters (74.8%) of the 556 participants reported receiving an STI test (44% <3 months ago; 32% 3–5 months ago; 13% 6–12 months ago; 10% >12 months ago); 12.1% reported ever receiving an STI diagnosis. In adjusted multivariable analyses, STI testing was associated with sociodemographic (education, location), individual (depression, perceived risk), social (relationship status, sexual stigma) and structural (healthcare provider access) factors. In multinomial analysis, reporting a less recent STI test (>3 months ago) versus <3 months ago was associated with increased likelihood of sexual stigma and food insecurity. Lifetime STI diagnosis was associated with sociodemographic (location), individual (HIV infection) and social (lower social support) factors. Conclusions: Findings document associations between structural factors and delayed timing of STI testing. Further research is necessary to explore how to address social ecological factors in sexual health interventions with MSM in Jamaica.
Additional keywords: Jamaica, men who have sex with men, sexually transmissible infections, STI testing, stigma, syphilis.
References
[1] Cohen J, Lo Y-R, Caceres CF, Klausner JD. For the WHO guideline working group. WHO guidelines for HIV/STI prevention and care among MSM and transgender people: implications for policy and practice. Sex Transm Infect 2013; 89 536–8.| For the WHO guideline working group. WHO guidelines for HIV/STI prevention and care among MSM and transgender people: implications for policy and practice.Crossref | GoogleScholarGoogle Scholar |
[2] Beyrer C, Baral SD, Collins C, Richardson ET, Sullivan PS, Sanchez J, Trapence G, Katabira E, Kazatchkine M, Ryan O, Wirtz AL, Mayer KH. The global response to HIV in men who have sex with men. Lancet 2016; 388 198–206.
| The global response to HIV in men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[3] Zoni AC, Gonzalez MA, Sjogren HW. Syphilis in the most at-risk populations in Latin America and the Caribbean: a systematic review. Int J Infect Dis 2013; 17 e84–92.
| Syphilis in the most at-risk populations in Latin America and the Caribbean: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[4] Figueroa JP, Cooper CJ, Edwards JK, Byfield L, Eastman S, Hobbs MM, Weir SS. Understanding the high prevalence of HIV and other sexually transmitted infections among socio-economically vulnerable men who have sex with men in Jamaica. PLoS One 2015; 10 e0117686
| Understanding the high prevalence of HIV and other sexually transmitted infections among socio-economically vulnerable men who have sex with men in Jamaica.Crossref | GoogleScholarGoogle Scholar |
[5] Figueroa JP, Weir SS, Jones-Cooper C, Byfield L, Hobbs MM, McKnight I, Cummings S. High HIV prevalence among men who have sex with men in Jamaica is associated with social vulnerability and other sexually transmitted infections. West Indian Med J 2013; 62 286–91.
[6] International Lesbian, Gay, Bisexual, Trans and Intersex Association (ILGA); Carrol A, Ramon Mendos L. State-sponsored homophobia: a world survey of sexual orientation laws: criminalisation, protection, and recognition. Geneva: ILGA; 2017. Available from: https://ilga.org/downloads/2017/ILGA_State_Sponsored_Homophobia_2017_WEB.pdf [verified 15 June 2018]
[7] West K. Understanding and reducing sexual prejudice in Jamaica: theoretical and practical insights from a severely anti-gay society. J Sex Res 2018 ; 55 472–85.
[8] West K. Sexual restrictions beyond anti-gay prejudice: anal sex, oral sex, masculinity and sexual prejudice in Jamaica. Int J Sex Health 2016; 28 278–85.
| Sexual restrictions beyond anti-gay prejudice: anal sex, oral sex, masculinity and sexual prejudice in Jamaica.Crossref | GoogleScholarGoogle Scholar |
[9] Semugoma P, Nemande S, Baral SD. The irony of homophobia in Africa. Lancet 2012; 380 312–4.
| The irony of homophobia in Africa.Crossref | GoogleScholarGoogle Scholar |
[10] Human Rights Watch. Letter to US global AIDS coordinator about “abstinence-only” funding and homophobia in Uganda. New York: Human Rights Watch; 2007.
[11] Carter M. PEPFAR money being used to “promote homophobia”, charges human rights group. London: NAM Publications; 2007. Available online https://www.aidsmap.com/PEPFAR-money-being-used-to-promote-homophobia-charges-human-rights-group/page/1428642/ [verified 15 June 2018]
[12] Kaoma JK. Colonizing African values: How the US Christian right is transforming sexual politics in Africa. Somerville, MA: Political Research Associates; 2012 Available online at: https://www.politicalresearch.org/wp-content/uploads/downloads/2012/10/Colonizing-African-Values.pdf [verified 16 June 2018].
[13] White RC, Carr R. Homosexuality and HIV/AIDS stigma in Jamaica. Cult Health Sex 2005; 7 347–59.
| Homosexuality and HIV/AIDS stigma in Jamaica.Crossref | GoogleScholarGoogle Scholar |
[14] Bain BC. Improving community care for persons with the acquired immunodeficiency syndrome in Jamaica. West Indian Med J 1998; 47 37–9.
[15] Wickramasuriya TV. Attitudes of medical students toward the acquired immune deficiency syndrome (AIDS). West Indian Med J 1995; 44 7–10.
[16] Norman LR, Carr R, Jimenez J. Sexual stigma and sympathy: attitudes toward persons living with HIV in Jamaica. Cult Health Sex 2006; 8 423–33.
| Sexual stigma and sympathy: attitudes toward persons living with HIV in Jamaica.Crossref | GoogleScholarGoogle Scholar |
[17] Rogers SJ, Tureski K, Cushnie A, Brown A, Bailey A, Palmer Q. Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas. AIDS Care 2014; 26 538–46.
| Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas.Crossref | GoogleScholarGoogle Scholar |
[18] Logie CH, Lee-Foon N, Jones N, Mena K, Levermore K, Newman PA, Andrinopoulos K, Baral S. Exploring lived experiences of violence and coping among lesbian, gay, bisexual and transgender youth in Kingston, Jamaica. Int J Sex Health 2016; 28 343–53.
| Exploring lived experiences of violence and coping among lesbian, gay, bisexual and transgender youth in Kingston, Jamaica.Crossref | GoogleScholarGoogle Scholar |
[19] Baral S, Logie C, Grosso A, Wirtz AL, Beyrer C. Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics. BMC Public Health 2013; 13 482
| Modified social ecological model: a tool to guide the assessment of the risks and risk contexts of HIV epidemics.Crossref | GoogleScholarGoogle Scholar |
[20] Parkhurst JO. Structural approaches for prevention of sexually transmitted HIV in general populations: definitions and an operational approach. J Int AIDS Soc 2014; 17 19052
| Structural approaches for prevention of sexually transmitted HIV in general populations: definitions and an operational approach.Crossref | GoogleScholarGoogle Scholar |
[21] Castillo R, Konda KA, Leon SR, Silva-Santisteban A, Salazar X, Klausner JD, Coates TJ, Cáceres CF. HIV and sexually transmitted infection incidence and associated risk factors among high-risk MSM and male-to-female transgender women in Lima, Peru. J Acquir Immune Defic Syndr 2015; 69 567–75.
| HIV and sexually transmitted infection incidence and associated risk factors among high-risk MSM and male-to-female transgender women in Lima, Peru.Crossref | GoogleScholarGoogle Scholar |
[22] Thomas B, Mimiaga MJ, Menon S, Chandrasekaran V, Murugesan P, Swaminathan S, Mayer KH, Safren SA. Unseen and unheard: predictors of sexual risk behavior and HIV infection among men who have sex with men in Chennai, India. AIDS Educ Prev 2009; 21 372–83.
| Unseen and unheard: predictors of sexual risk behavior and HIV infection among men who have sex with men in Chennai, India.Crossref | GoogleScholarGoogle Scholar |
[23] Stahlman S, Grosso A, Ketende S, Ketende S, Sweitzer S, Mothopeng T, Taruberekera N, Nkonyana J, Baral S. Depression and social stigma among MSM in Lesotho: implications for HIV and sexually transmitted infection prevention. AIDS Behav 2015; 19 1460–9.
| Depression and social stigma among MSM in Lesotho: implications for HIV and sexually transmitted infection prevention.Crossref | GoogleScholarGoogle Scholar |
[24] Goodman SH, Grosso AL, Ketende SC, Ouedraogo GH, Kouanda S, Ky-Zerbo O, Samadoulougou C, Baral S. Examining the correlates of sexually transmitted infection testing among men who have sex with men in Ouagadougou and Bobo-Dioulasso, Burkina Faso. Sex Transm Dis 2016; 43 302–9.
| Examining the correlates of sexually transmitted infection testing among men who have sex with men in Ouagadougou and Bobo-Dioulasso, Burkina Faso.Crossref | GoogleScholarGoogle Scholar |
[25] McDaid LM, Li J, Knussen C, Flowers P. Sexually transmitted infection testing and self-reported diagnoses among a community sample of men who have sex with men, in Scotland. Sex Transm Infect 2013; 89 223–30.
| Sexually transmitted infection testing and self-reported diagnoses among a community sample of men who have sex with men, in Scotland.Crossref | GoogleScholarGoogle Scholar |
[26] Wong W, Chaw JK, Kent CK, Klausner JD. Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002–2003. Sex Transm Dis 2005; 32 458–63.
| Risk factors for early syphilis among gay and bisexual men seen in an STD clinic: San Francisco, 2002–2003.Crossref | GoogleScholarGoogle Scholar |
[27] Zablotska IB, Imrie J, Bourne C, Grulich AE, Frankland A, Prestage G. Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007. Int J STD AIDS 2008; 19 758–60.
| Improvements in sexual health testing among gay men in Sydney, Australia, 2003–2007.Crossref | GoogleScholarGoogle Scholar |
[28] Nelson KM, Thiede H, Jenkins RA, Carey JW, Hutcheson R, Golden MR. Personal and contextual factors related to delayed HIV diagnosis among men who have sex with men. AIDS Educ Prev 2014; 26 122–33.
| Personal and contextual factors related to delayed HIV diagnosis among men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[29] Andrinopoulos K, Hembling J, Guardado ME, de Maria Hernandez F, Nieto AI, Melendez G. Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador, El Salvador. AIDS Behav 2015; 19 60–71.
| Evidence of the negative effect of sexual minority stigma on HIV testing among MSM and transgender women in San Salvador, El Salvador.Crossref | GoogleScholarGoogle Scholar |
[30] Logie CH, Lacombe-Duncan A, Brien N, Lee-Foon N, Levermore K, Marshall A, Nyblade L, Newman PA. Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. J Int AIDS Soc 2017; 20 –21385.
| Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[31] Baral S, Holland CE, Shannon K, Logie C, Semugoma P, Sithole B, Papworth E, Drame F, Beyrer C. Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs. J Acquir Immune Defic Syndr 2014; 66 S319–28.
| Enhancing benefits or increasing harms: community responses for HIV among men who have sex with men, transgender women, female sex workers, and people who inject drugs.Crossref | GoogleScholarGoogle Scholar |
[32] Visser M, Heijne JCM, Hogewoning AA, van Aar F. Frequency and determinants of consistent STI/HIV testing among men who have sex with men testing at STI outpatient clinics in the Netherlands: a longitudinal study. Sex Transm Infect 2017; [e-pub ahead of print]
| Frequency and determinants of consistent STI/HIV testing among men who have sex with men testing at STI outpatient clinics in the Netherlands: a longitudinal study.Crossref | GoogleScholarGoogle Scholar |
[33] Weiss KM, Jonas KJ, Guadamuz TE. Playing and never testing: human immunodeficiency virus and sexually transmitted infection testing among app-using MSM in Southeast Asia. Sex Transm Dis 2017; 44 406–11.
| Playing and never testing: human immunodeficiency virus and sexually transmitted infection testing among app-using MSM in Southeast Asia.Crossref | GoogleScholarGoogle Scholar |
[34] Platt L, Wall M, Rhodes T, Judd A, Hickman M, Johnston LG, Renton A, Bobrova N, Sarang A. Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia. J Urban Health 2006; 83 39–53.
| Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia.Crossref | GoogleScholarGoogle Scholar |
[35] Mehra B, Bhattar S, Saxena S, Rawat D, Bhalla P. Evaluation of SD BIOLINE Syphilis 3.0 for rapid diagnosis of syphilis: report from a regional sexually transmitted infection reference laboratory in North India. J Lab Physicians 2016; 8 36–40.
| Evaluation of SD BIOLINE Syphilis 3.0 for rapid diagnosis of syphilis: report from a regional sexually transmitted infection reference laboratory in North India.Crossref | GoogleScholarGoogle Scholar |
[36] Centers for Disease Control and Prevention. STD & HIV screening recommendations 2017. Atlanta: U.S. Department of Health & Human Services; 2017. Available from: https://www.cdc.gov/std/prevention/screeningreccs.htm [Verified 24 May 18].
[37] Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41 1284–92.
| The Patient Health Questionnaire-2: validity of a two-item depression screener.Crossref | GoogleScholarGoogle Scholar |
[38] Kalichman SC, Rompa D, Difonzo K, Simpson D, Kyomugisha F, Austin J, Webster L. Initial development of scales to assess self-efficacy for disclosing HIV status and negotiating safer sex in HIV-positive persons. AIDS Behav 2001; 5 291–6.
| Initial development of scales to assess self-efficacy for disclosing HIV status and negotiating safer sex in HIV-positive persons.Crossref | GoogleScholarGoogle Scholar |
[39] Bernal G, Maldonado Molina MM, Scharrón del Río MR. Development of a brief scale for social support: reliability and validity in Puerto Rico. Int J Clin Hlth Psychol 2003; 3 251–64.
[40] Díaz RM, Ayala G, Bein E, Henne J, Martin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health 2001; 91 927–32.
| The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities.Crossref | GoogleScholarGoogle Scholar |
[41] Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, Ekstrand ML. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med 2008; 67 1225–35.
| HIV-related stigma: adapting a theoretical framework for use in India.Crossref | GoogleScholarGoogle Scholar |
[42] Norman LR, Uche C. Prevalence and determinants of sexually transmitted diseases: an analysis of young Jamaican males. Sex Transm Dis 2002; 29 126–32.
| Prevalence and determinants of sexually transmitted diseases: an analysis of young Jamaican males.Crossref | GoogleScholarGoogle Scholar |
[43] Lofters AK. The “brain drain” of health care workers: causes, solutions and the example of Jamaica. Can J Public Health 2012; 103 e376–8.
[44] The Gleaner. Fixing health: restructuring Jamaica’s health sector for 2016. Kingston: The Gleaner Company (Media) Limited; 2015. Available online at: http://jamaica-gleaner.com/article/health/20151125/fixing-health-restructuring-jamaicas-health-sector-2016 [verified 16 June 2018]
[45] Caribbean National Weekly. Jamaica’s healthcare system in dire need of help. Davie: Carbibbean National Weekly; 2017. Available online at: https://www.caribbeannationalweekly.com/editorial/jamaicas-healthcare-system-dire-need-help/ [verified 16 June 2018]
[46] Ober AJ, Martino SC, Ewing B, Tucker JS. If you provide the test, they will take it: factors associated with HIV/STI testing in a representative sample of homeless youth in Los Angeles. AIDS Educ Prev 2012; 24 350–62.
| If you provide the test, they will take it: factors associated with HIV/STI testing in a representative sample of homeless youth in Los Angeles.Crossref | GoogleScholarGoogle Scholar |
[47] Jacob KS. Mental health services in low-income and middle-income countries. Lancet Psychiatry 2017; 4 87–9.
| Mental health services in low-income and middle-income countries.Crossref | GoogleScholarGoogle Scholar |
[48] Chen M, Guy R. Increasing syphilis rates among men who have sex with men and screening to detect asymptomatic infection. Sex Health 2017; 14 301–3.
[49] Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc 2009; 12 15
[50] Lovell JS. ‘We are Jamaicans:’ living with and challenging the criminalization of homosexuality in Jamaica. Contemp Justice Rev 2016; 19 86–102.
| ‘We are Jamaicans:’ living with and challenging the criminalization of homosexuality in Jamaica.Crossref | GoogleScholarGoogle Scholar |
[51] West K. Jamaica, three years later: effects of intensified pro-gay activism on severe prejudice against lesbians and gay men. J Sex Res 2016; 53 1107–17.
| Jamaica, three years later: effects of intensified pro-gay activism on severe prejudice against lesbians and gay men.Crossref | GoogleScholarGoogle Scholar |
[52] Dean HD, Fenton KA. Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis. Public Health Rep 2010; 125 1–5.
| Addressing social determinants of health in the prevention and control of HIV/AIDS, viral hepatitis, sexually transmitted infections, and tuberculosis.Crossref | GoogleScholarGoogle Scholar |
[53] Jones AA, Striley CW, Cottler LB. Prescription opioid use, illicit drug use, and sexually transmitted infections among participants from a community engagement program in North Central Florida. J Subst Use 2017; 22 90–5.
| Prescription opioid use, illicit drug use, and sexually transmitted infections among participants from a community engagement program in North Central Florida.Crossref | GoogleScholarGoogle Scholar |
[54] Kerr J, Maticka-Tyndale E, Bynum S, Mihan R. Sexual networking and partner characteristics among single, African, Caribbean, and Black Youth in Windsor, Ontario. Arch Sex Behav 2017; 46 1891–9.
| Sexual networking and partner characteristics among single, African, Caribbean, and Black Youth in Windsor, Ontario.Crossref | GoogleScholarGoogle Scholar |
[55] Gordon-Strachan G, Bailey W, Henry-Lee A, Barnett J, Lalta S, Alleyne D. The impact of user fees for preventive health care – Jamaica. Social and Economic Studies 2010; 59 123–52.
[56] Beyrer C, Sullivan PS, Sanchez J, Dowdy D, Altman D, Trapence G, Collins C, Katabira E, Kazatchkine M, Sidibe M, Mayer KH. A call to action for comprehensive HIV services for men who have sex with men. Lancet 2012; 380 424–38.
| A call to action for comprehensive HIV services for men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[57] World Health Organization. Global health sector strategy on HIV 2016–2021. Towards ending AIDS. Geneva: World Health Organization; 2016.
[58] Deuba K, Ekström AM, Shrestha R, Ionita G, Bhatta L, Karki DK. Psychosocial health problems associated with increased HIV risk behavior among men who have sex with men in Nepal: a cross-sectional survey. PLoS One 2013; 8 e58099
| Psychosocial health problems associated with increased HIV risk behavior among men who have sex with men in Nepal: a cross-sectional survey.Crossref | GoogleScholarGoogle Scholar |
[59] Teng Y, Mak WWS. The role of planning and self-efficacy in condom use among men who have sex with men: an application of the health action process approach model. Health Psychol 2011; 30 119–28.
| The role of planning and self-efficacy in condom use among men who have sex with men: an application of the health action process approach model.Crossref | GoogleScholarGoogle Scholar |
