BY NADINE WILSON
NEW data showing a 32 per cent HIV prevalency rate among men who sleep with men (MSM) in Jamaica have reignited fears that the sexual practices of this largely underground community could erode gains made over the years in curbing the HIV/AIDS epidemic.
According to Jamaica's National HIV Strategic Plan for 2012-2017, there are an estimated 33,000 MSMs in the country, but health officials say interventions targeted at this group have mostly failed because these men fear discrimination if their sexual activities are revealed.
A survey of the MSM community in 2007 showed that as many as 56 per cent had at least one female partner in the course of that year and almost 64 per cent identified themselves as bi-sexual. Only 57 per cent had ever done an HIV test, although almost 30 per cent of them had sex with multiple male partners within the four weeks prior to the survey. Only 67 per cent reported using a condom during their last sexual encounter with their main male partner, while 62 per cent reported doing so with their female partner.
What is particularly worrying to health officials is the fact that the MSM community is, for the most part, a 'bridge' population which is contributing to the increasing rate of HIV seen in women.
AIDS remains a leading cause of death among Jamaicans 15-49 years, with approximately 74 per cent of all AIDS cases in the island being within that age group. There were over 300 reported AIDS deaths in 2010 and as many as 2,100 Jamaicans estimated to become newly infected each year. This, despite the country making significant inroads in reducing the number of cases over the last few years with the introduction of a public access anti-retroviral (ARV) treatment programme in 2004. AIDS cases are highest among men.
Project co-ordinator at the Caribbean Vulnerable Communities Coalition, Ivan Cruickshank told the Jamaica Observer the country is courting disaster.
"When we look at the rates of HIV among the MSM population, if we are not able to reach them effectively with HIV prevention, we really have a serious epidemic on our hands...," he said.
Acting director of the Ministry of Health's National HIV/STI programme, Dr Nicola Skyers, has said that while the ministry has been interfacing with MSMs in the lower socio-economic strata of the society, getting access to MSMs in the middle and upper classes has been extremely difficult.
"We do recognise that ignoring these subsets will cause an explosion within the general population because we know that there is a bridge. Men just don't have sex with men, they have sex with women as well, so we do recognise the risk of ignoring these particular populations," she told the Observer.
Cruickshank explained that MSMs with affluence rarely utilised the public health-care system which would enable policy-makers to fully grasp data on the community. Most, he said, usually seek treatment at private facilities or overseas.
"There is so much to lose that a lot of persons refuse to access health care because some of the questions that might be asked [and] some of the issues that they might need to take to the health care provider are issues that would identify their sexual practices," he said. He also noted that some of these men are also in heterosexual unions and do not want to risk their relationships with their female partners.
One male sex worker who has been offering his services to males since 2005 told the Observer that most of his clients were influential and wealthy men who had wives and children. He admitted that he did not use a condom with these men during his earlier years in the profession, and THATother male sex workers he knows still do not use them.
"When you are with these persons who are of good character in society, you don't perceive a risk because of the position that they are in. Because this person is a manager,or so forth, you don't perceive that they would be running around, and that sort of thing. [Because] they are protective of their families, you are willing to take your chances with that person, versus someone who is not 'up there' (affluent), who, in my head, is of greater risk because they might be sleeping around with any or everybody," he said.
He said some male sex workers "are flamboyant and dress effeminately" and so they sometimes chose not to access public health care because they fear being discriminated against, although their more affluent clients were able to easily access treatment through their private doctors. Most of their clients, he confirmed, are unknown to persons monitoring HIV/AIDS intervention programmes or policy-makers.
According to the National HIV Strategic Plan, the sexual practices of 40 per cent of reported male AIDS cases in Jamaica are classified as 'unknown', "and may reflect under-reporting by MSMs who are unwilling to reveal their sexual practices, as well as incomplete reporting."
This unavailability of data is a significant weakness in the surveillance system.
"The high rates of HIV infection and bisexuality among MSMs are likely to be important factors currently driving the HIV epidemic in Jamaica," the report noted.
The new National HIV Strategic Plan, which succeeds the current plan that ends in 2012, pointed to "an urgent need to identify remedial actions" so as not to jeopordise future funding, especially from global agencies that target at-risk populations.
"Specific approaches will be developed to reach subgroups of MSM: male sex workers, adolescent MSM, PLHIV (persons living with HIV), transgender, and bisexuals in upper social classes, as well as other MSM with money, power and influence who are usually the decision makers in the sexual relationship," the plan noted.