Jamaica AIDS Support for Life (JASL) in partnership with Dr. Carmen Logie, Canada Research Chair in Global Health Equity and Social Justice with Marginalised Populations and Associate Professor from the Factor-Inwentash Faculty of Social Work, University of Toronto, Canada along with other collaborators, have produced the following research papers:
1 – Pathways from Police, Intimate Partner, and Client Violence to Condom Use Outcomes among Sex Workers in Jamaica.
Citation: Logie et al. (2020). Pathways from Police, Intimate Partner, and Client Violence to Condom Use Outcomes among Sex Workers in Jamaica. International Journal of Behavioral Medicine. https://doi.org/10.1007/s12529-020-09860-1, 1-11.
Background: Violence reduces sex workers’ ability to enforce consistent condom use. Less is known of violence and condom use among gender diverse sex workers in Jamaica, where both sex work and same-sex practices are criminalized. We examined pathways from violence to consistent condom use among sex workers in Jamaica.
Methods: We conducted a cross-sectional survey with a peer-driven sample of sex workers (n = 340: n = 124 cisgender men, n =115 cisgender women, n = 101 transgender women) in Kingston, Ocho Rios, and Montego Bay, Jamaica. We conducted structural equation modeling using weighted least square estimation methods to test the direct effects of police harassment (ever), intimate partner violence (IPV) (ever), and recent (past 6-month) client violence on consistent condom use, and indirect effects via condom use self-efficacy, adjusting for socio-demographic factors. Moderation analysis was conducted to estimate the effect of binge drinking on condom use self-efficacy. We conducted a second SEM taking into consideration measurement invariance to test gender differences.
Results: Over half of participants reported police harassment, half intimate partner violence, and one-third client violence. Overall, the direct path from police harassment to consistent condom use was significant. Condom use self-efficacy mediated associations between client violence and IPV with consistent condom use. Binge drinking moderated the association between client violence and condom use self-efficacy. There were gender differences in these pathways.
Conclusions: Violence has direct and indirect effects on condomuse outcomes among sex workers in Jamaica. Multilevel, gender-tailored interventions at policy, police, and community levels can promote sex workers’ health and human rights.
Keywords: Jamaica . Condom use . Condom efficacy . Violence . Sexwork
2 – Adapting the psychological mediation framework for cisgender and transgender sexual minorities in Jamaica: Implications from latent versus observed variable approaches to sexual stigma
Citation: Logie et al. (2019). Adapting the psychological mediation framework for cisgender and transgender sexual minorities in Jamaica: Implications from latent versus observed variable approaches to sexual stigma. Social Science & Medicine, 245 (2020) 112663, 1-10.
Rationale: Sexual minorities’ mental health disparities are produced in larger contexts of sexual stigma. There is limited understanding of pathways between sexual stigma dimensions (e.g., enacted, perceived, internalized), psychological processes, and depression.
Objective: We aimed to test the psychological mediation framework among transgender and cisgender sexual minorities in Kingston, Montego Bay, and Ocho Rios, Jamaica.
Methods: We conducted structural equation modeling using maximum likelihood estimation to examine direct and indirect pathways from sexual stigma to recent (past 2-week) depressive symptoms via mediators of resilient coping, social support quantity, and empowerment, and the moderation effect of social support quality.
Results: Model 1 used a latent sexual stigma construct (indicators: enacted, perceived, and internalized stigma dimensions). Model 2 examined sexual stigma dimensions (enacted, perceived, internalized) as observed variables. Among participants (n=871; mean age: 25.5, SD: 5.4), 90.82% reported recent depressive symptoms. Both models fit the data well. In Model 1, the sexual stigma latent construct had a significant direct effect on depressive symptoms; social support quantity and resilient coping were partial mediators. In Model 2, enacted sexual stigma had a significant direct effect on depressive symptoms. Internalized sexual stigma had a significant indirect effect via social support quantity, resilient coping, and empowerment. Perceived sexual stigma had an indirect effect on depressive symptoms via empowerment. Social support quality moderated the relationship between: internalized stigma and empowerment, empowerment and resilient coping, social support quantity and resilient coping, and resilient coping and depressive symptoms. Conclusion: Findings suggest the importance of considering the synergistic effect of multiple sexual stigma dimensions on depression; exploring different sexual stigma dimensions to inform tailored stigma reduction and stigma coping interventions; and addressing coping (e.g., resilience), social isolation (e.g., social support quantity/quality), and cognitive (e.g., empowerment) factors to mitigate the impacts of sexual stigma on depression among sexual minorities.
3 – Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica
Citation: Logie et al. (2019). Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica. AIDS and Behavior, 23, 1530–1540.
Syndemics approaches explore the convergence of psychosocial factors that elevate HIV vulnerabilities. Less research has explored syndemics among lesbian, gay, bisexual and transgender (LGBT) persons in contexts where criminalization has downstream impacts on LGBT discrimination, such as Jamaica. We implemented a cross-sectional survey with LGBT persons (n = 911) in Jamaica. We conducted structural equation modeling to examine direct and indirect effects of a latent syndemics construct (binge drinking, depressive symptoms, childhood/adult abuse) on HIV vulnerabilities (lifetime sex partners, perceived HIV risk, condom self-efficacy) and the mediating role of protective factors (social support, resilient coping). Direct paths from syndemics to lifetime sex partners, perceived HIV risk, and condom self-efficacy were significant. Resilient coping and social support partially mediated the association between syndemics and condom use self-efficacy. Resilient coping partially mediated the relationship between syndemics and lifetime sex partners. Interventions can target syndemic issues to reduce HIV vulnerabilities among Jamaican LGBT persons.
Keywords: Syndemics · LGBT · Resilience · Jamaica · HIV risk · Social support
4 – Contextualising sexual health practices among lesbian and bisexual women in Jamaica: a multi-methods study
Citation: Logie et al. (2018). Contextualising sexual health practices among lesbian and bisexual women in Jamaica: a multimethods study. RHM Journal, Volume 26, 2018 – Issue 52, 109-127.
Limited research has examined lesbian and bisexual women’s sexual health practices in the Caribbean, where lesbian and bisexual women experience sexual stigma that may reduce sexual healthcare utilisation. We conducted a sequential multi-method research study, including semi-structured individual interviews (n = 20) and a focus group (n = 5) followed by a cross-sectional survey (n = 205) with lesbian and bisexual women in Kingston, Montego Bay, and Ocho Rios, Jamaica. Binary logistic analyses and ordinal logistic regression were conducted to estimate the odds ratios for social-ecological factors associated with lifetime STI testing, sex work involvement, and the last time of STI testing. Over half of participants reported a lifetime STI test and of these, 6.1% reported an STI diagnosis. One-fifth of the sample reported ever selling sex. Directed content analysis of women’s narratives highlighted that stigma and discrimination from healthcare providers, in combination with low perceived STI risk, limited STI testing access and safer sex practices. Participants described how safer sex self-efficacy increased their safer sex practices. Quantitative results revealed that a longer time since last STI test was positively associated with depression, sexual stigma, and forced sex, and negatively associated with residential location, perceived STI risk, safer sex self-efficacy, and LGBT connectedness. Selling sex was associated with perceived STI risk, relationship status, sexual stigma, food insecurity, and forced sex. Sexual health practices among lesbian and bisexual women in Jamaica are associated with intrapersonal, interpersonal, and structural factors, underscoring the urgent need for multilevel interventions to improve sexual health and advance sexual rights among lesbian and bisexual women in Jamaica. DOI: 10.1080/09688080.2018.1517543
Keywords: Beveloping world, Homosexuality, Lesbians, Women, testing, STI, Stigma, Jamaica, Bisexuality, Sexual health
5 – Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica.
Citation: Logie et al. (2018). Navigating stigma, survival, and sex in contexts of social inequity among young transgender women and sexually diverse men in Kingston, Jamaica. RHM Journal, Volume 26, 2018 – Issue 54, 72-83.
Social inequities, including stigma, criminalisation of same-sex practices, and poverty, elevate HIV exposure among young transgender women and sexually diverse men in Jamaica. Yet the ways transgender women and sexually diverse men in Jamaica navigate sex and HIV in contexts of social inequity are underexplored. The study objective was to explore experiences and perceptions of sexual decision-making and HIV risk among young (aged 18–30) sexually diverse men and transgender women in Kingston, Jamaica. We conducted a community-based qualitative study in Kingston that involved in-depth individual interviews (transgender women: n = 20; sexually diverse men: n = 20), 2 focus groups (transgender women: n = 8; sexually diverse men: n = 10) and 13 key informant interviews. Focus groups and interviews were digitally recorded, transcribed verbatim, and analysed with a thematic approach. Findings suggest that transgender women and sexually diverse men in Kingston are aware of, and managing survival challenges and HIV risks in contexts of social inequity. Daily survival challenges include stigma and a lack of human rights protections that contributed to barriers to employment, housing, healthcare, education, and exposure to violence. Challenges maintaining sexual relationships included the need to hide for safety, often resulting in difficulties forming lasting relationships. These survival and relationship challenges converged to lower self-esteem and self-acceptance. In the face of these challenges, participants navigated sexual risk and pleasure. Findings provide insight into agency and sexual decision-making processes in contexts of social inequities. Findings can inform multi-level strategies to promote social equity, sexual health, and HIV prevention with young transgender women and sexually diverse men in Jamaica. DOI: 10.1080/09688080.2018.1538760
Keywords: transgender women, gay men, stigma, sexual rights, sexual health, Jamaica
6 – Pathways From Sexual Stigma to Inconsistent Condom Use and Condom Breakage and Slippage Among MSM in Jamaica
Citation: Logie et al. (2018). Pathways From Sexual Stigma to Inconsistent Condom Use and Condom Breakage and Slippage Among MSM in Jamaica. Journal of Acquired Immune Deficiency Syndrome, Volume 78, Number 5, 513-52
Background: HIV prevalence among men who have sex with men (MSM) in Jamaica, where same sex practices are criminalized, is among the Caribbean’s highest. Sexual stigma, the devaluation, mistreatment, and reduced power afforded to sexual minorities, is a distal driver of HIV vulnerabilities. The mechanisms accounting for associations between sexual stigma and condom use outcomes are underexplored. We examined pathways from sexual stigma to condom use and condom breakage and/or slippage among MSM in Jamaica.
Methods: We conducted a cross-sectional survey with a chain referral sample of MSM (n = 556) in Kingston, Montego Bay, and Ocho Rios. Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of sexual stigma on inconsistent condom use and condom breakage/slippage, and the indirect effects through depression, sexual abuse history, and condom use self-efficacy, adjusting for sociodemographic factors.
Results: One-fifth of participants (21%; 90/422) who had engaged in anal sex reported inconsistent condom use, and 38% (155/410) reported condom breakage/slippage during the previous 4 weeks. The relationship between sexual stigma and inconsistent condom use was mediated by the combination effect of sexual abuse history, condom use self-efficacy, and depression. The relationship between sexual stigma and condom breakage and slippage was mediated by the combination effect of condom use self-efficacy and sexual abuse history.
Conclusions: Sexual stigma is associated with negative condom use outcomes in Jamaican MSM, mediated by psychosocial factors. Multilevel social ecological approaches to the HIV prevention cascade can inform interventions at individual, interpersonal, community, and systemic levels.
Key Words: MSM, Jamaica, stigma, condom use, condom efficacy, condom breakage
(J Acquir Immune Defic Syndr 2018;78:513–521)
7 – Social–ecological factors associated with HIV infection among men who have sex with men in Jamaica. International Journal of STD and AIDS
Citation: Logie et al. (2017). Social–ecological factors associated with HIV infection among men who have sex with men in Jamaica. International Journal of STD and AIDS, 0(0), 1-9.
In Jamaica, where homosexuality is criminalized, scant research has examined associations between sexual stigma and HIV infection. The study objective was to examine correlates of HIV infection among men who have sex with men (MSM) in Jamaica. We conducted a cross-sectional tablet-based survey with MSM in Jamaica using chain referral sampling. We assessed socio-demographic, individual, social, and structural factors associated with HIV infection. A logit-link model, fit using backwards-stepwise regression, was used to estimate a final multivariable model. Among 498 participants (median age: 24, interquartile range: 22–28), 67 (13.5%) were HIV-positive. In the multivariable model, HIV infection was associated with increased odds of socio-demographic (older age, odds ratio [OR]: 1.05, 95% confidence interval [CI]:1.00–1.10]; residing in Kingston versus Ocho Rios [OR: 6.99, 95% CI 2.54–19.26]), individual (poor/fair versus excellent/good self-rated health [OR: 4.55, 95% CI: 1.81–11.42], sexually transmitted infection [STI] history [OR: 3.67, 95% CI:1.61–8.38]), and structural (enacted sexual stigma [OR: 1.08, 95% CI: 1.01–1.15], having a health care provider [OR: 2.23, 95% CI: 1.06–4.66]) factors. This is among the first studies to demonstrate associations between sexual stigma and HIV infection in Jamaica. Findings underscore the need to integrate STI testing in the HIV care continuum and to address stigma and regional differences among MSM in Jamaica.
Keywords: Jamaica, HIV, men who have sex with men, health disparities
8 – Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study
Citation: Logie et al. (2017). Barriers and facilitators to HIV testing among young men who have sex with men and transgender women in Kingston, Jamaica: a qualitative study. Journal of the International AIDS Society, 20:21385, 1-8.
Introduction: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords: HIV testing; Jamaica; MSM; gay; transgender; youth; stigma; discrimination
9 – Logie et al. (2017). Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study. Journal of the International AIDS Society, 20:21422, 1-10.
10 – Logie et al. (2017). Conceptualizing empowerment practice with lesbian, gay, bisexual and transgender youth in Jamaica. Social Work Education, 36:4, 456-465.
11 – Logie et al. (2016). Exploring Lived Experiences of Violence and Coping Among Lesbian, Gay, Bisexual and Transgender Youth in Kingston, Jamaica. International Journal of Sexual Health. International Journal of Sexual Health, VOL. 28, NO. 4, 343–353
12 – Logie et al. (2018). 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. Sexual Health, 15(4) 325-334.
13 – Logie et al. (2018). Factors Associated With Syphilis Testing and a History of Syphilis Infection Among a Sample of Transgender Women in Jamaica. International STDs, Volume 45, Number 3, 158-162.
For open access to the full text for any of the mentioned research papers, please contact Dr. Logie at https://www.researchgate.net/profile/Carmen_Logie