Layered Stigma among Health Facility and Social Services Staff toward Most-at-Risk Populations in Jamaica

This report was prepared by independent consultants Audrey Brown, MSc, DLSHTM, Althea
Bailey, MPH, and Quaine Palmer, MEd; and by Kara Tureski, MPH, Susan J. Rogers, PhD, Anya Cushnie, MIH, and Abidemi Adelaja, MPH from C-Change/FHI 360.

This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) under the terms of Agreement No. GPO-A-00-07-00004-00. The contents are the responsibility of the C-Change project, managed by FHI 360, and do not necessarily reflect the views of USAID or the United States Government.

Executive Summary

FHI 360’s Communication for Change (C-Change) project, funded by USAID/PEPFAR, in
Jamaica provides technical assistance in social and behavior change communication (SBCC) to
improve the quality and scale of Jamaica’s response to the HIV and AIDS epidemic. In keeping with its mandate of supporting civil society and government partners in developing evidencebased programming and in working to create supportive enabling environments for most-at-risk populations (MARPs), C-Change conducted a study in 2011 on stigma and discrimination (S&D) within health and social services settings toward persons living with HIV (PLHIV), men who have sex with men (MSM), and sex workers (SW).

S&D occurs when someone is devalued as a result of practices, behaviors, diseases or other characteristics with which they are associated (International Center for Research on Women 2012). MSM and SW are among the most heavily stigmatized groups due to their own unique identifications and the socio-cultural hostilities and fears associated with them. The resulting S&D creates an environment that is intimidating and that increases vulnerabilities for infection, abuse, and death among these groups as they relate to accessing crucial prevention and treatment information and services, quality of services received, and treatment, among others. S&D norms within health services often mirror and mutually reinforce wider social norms. Within health care settings, S&D is particularly of concern given its impact on the ability of those stigmatized to receive appropriate and quality prevention services, treatment, and care.

Along with examining the level of S&D in within health facilities and social services environments, the study sought to understand the association between staff training, or the lack thereof, and reported S&D. It also sought to explore the degree to which layered stigma existed.

Layered stigma is HIV–related stigma combined with stigma toward marginalized groups—a scenario MSM and SW frequently experience as they are often assumed to be core transmitters of HIV infection. Prevalence data show that close to a third of the population of MSM and 4.2 percent of SW in Jamaica are HIV–infected (Jamaica National HIV/STI Program 2010), and S&D of MARPs is a major barrier to their access of health and social services that can help mitigate the growing HIV and AIDS epidemic. With these statistics in mind the overall aim of the study was to inform critical SBCC interventions for the health and social services sectors.

The study was conducted in Kingston, Montego Bay, and Ocho Rios. It included three components with separate samples: 165 health services staff in 23 public, private, or NGOowned health facilities identified as either MARP–friendly or a general facility; 63 staff members of 12 social services organizations that provided support services to MARPs; and 450 male and female sex workers located in popular sites/locations (i.e., clubs, streets, massage parlors, the beach, hotels, guest houses, and bars). Modified survey instruments were pretested and used for each of the components with items adapted from previously tested instruments (Nyblade and MacQuarrie 2006; Kelly et al. 1987; Berger, Estwing, and Lashley 2001).

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