Evidence of the Negative Effect of Sexual Minority Stigma on HIV Testing Among MSM and Transgender Women in San Salvador, El Salvador

Andrinopoulos, Katherine; Hembling, John; Guardado, María Elena; Hernández, Flor de Maria; Nieto, Ana; Melendez, Giovanni

doi:10.1007/s10461-014-0813-0

Cited by 70 publications

(81 citation statements)

References 35 publications

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“…Our finding that over 47% of transgender participants reported sex work for money in the past year is similar to studies with transgender women that report rates of sex work from 40 to 60% in Peru [3] and 33% in El Salvador [41]. We found approximately one-quarter of participants reported transactional sex in exchange for food, transportation, accommodation, drugs or alcohol.…”

Section: Discussionsupporting

confidence: 86%

“…We found approximately one-quarter of participants reported transactional sex in exchange for food, transportation, accommodation, drugs or alcohol. This is similar to findings that approximately one-third of samples of transgender women in San Salvador, El Salvador ( n = 670) [41], and MSM in Jamaica ( n = 449) reported transactional sex [15]. …”

Section: Discussionsupporting

confidence: 85%

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Factors associated with sex work involvement among transgender women in Jamaica: a cross‐sectional study

Logie

Wang

Lacombe‐Duncan

et al. 2017

Journal of the International AIDS Society

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Introduction: Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica.Methods: In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex.Results: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement.Conclusions: Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Factors associated with sex work involvement among transgender women in Jamaica: a cross‐sectional study

Logie

Wang

Lacombe‐Duncan

et al. 2017

Journal of the International AIDS Society

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“…Sexual stigma may limit access to education and employment, threatening economic security [5]. In addition, sexual stigma, sex work, and HIV-related stigma may limit access to sexual health and HIV information, prevention, and testing and care services [44,45]. Both qualitative [46] and quantitative [47–50] studies describe stigmatizing attitudes by university students and health/social service providers towards people living with HIV and lesbian, gay, bisexual, and transgender (LGBT) persons in Jamaica, with the highest levels of stigma directed towards MSM living with HIV [49,50].…”

Section: Introductionmentioning

confidence: 99%

Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey

Logie

Lacombe‐Duncan

Kenny

et al. 2018

Global Health Action

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Background: Globally, men who have sex with men (MSM) experience social marginalization and criminalization that increase HIV vulnerability by constraining access to HIV prevention and care. People who sell sex also experience criminalization, rights violations, and violence, which elevate HIV exposure. MSM who sell sex may experience intersectional stigma and intensified social marginalization, yet have largely been overlooked in epidemiological and social HIV research. In Jamaica, where same sex practices and sex work are criminalized, scant research has investigated sex selling among MSM, including associations with HIV vulnerability. Objective: We aimed to examine social ecological factors associated with selling sex among MSM in Jamaica, including exchanging sex for money, shelter, food, transportation, or drugs/alcohol (past 12 months). Methods: We conducted a cross-sectional survey with a peer-driven sample of MSM in Kingston, Ocho Rios, and Montego Bay. Multivariable logistic regression analyses were conducted to estimate intrapersonal/individual, interpersonal/social, and structural factors associated with selling sex. Results: Among 556 MSM, one-third (n = 182; 32.7%) reported selling sex. In the final multivariable model, correlates of selling sex included: individual/intrapersonal (lower safer sex self-efficacy [AOR: 0.85, 95% CI: 0.77, 0.94]), interpersonal/social (concurrent partnerships [AOR: 5.52, 95% CI: 1.56, 19.53], a higher need for social support [AOR: 1.08, 95% CI: 1.03, 1.12], lifetime forced sex [AOR: 2.74, 95% 1.65, 4.55]) and structural-level factors (sexual stigma [AOR: 1.09, 95% CI: 1.04, 1.15], food insecurity [AOR: 2.38, 95% CI: 1.41, 4.02], housing insecurity [AOR: 1.94, 95% CI: 1.16, 3.26], no regular healthcare provider [AOR: 2.72, 95% CI: 1.60, 4.64]). Conclusions: This study highlights social ecological correlates of selling sex among MSM in Jamaica, in particular elevated stigma and economic insecurity. Findings suggest that MSM in Jamaica who sell sex experience intensified social and structural HIV vulnerabilities that should be addressed in multi-level interventions to promote health and human rights.

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“…In addition, most prevention efforts were directed to the general population, rather than to specific subpopulations, in spite of El Salvador’s concentrated epidemic. Although the overall HIV rate is low at 0.8%, it is much higher among men who have sex with men (MSM) with a prevalence estimated at 10.5%, commercial sex workers (CSW) with a prevalence of 3.1%, and transgender women (TW) with a prevalence of 19% (Andrinopoulos et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

Combination HIV Prevention Strategy Implementation in El Salvador: Perceived Barriers and Adaptations Reported by Outreach Peer Educators and Supervisors

Buck

Dickson‐Gómez

Bodnar³

2017

Global Qualitative Nursing Research

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El Salvador was one of three countries to receive funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria to conduct a combination HIV prevention intervention among transwomen (TW), men who have sex with men (MSM), and commercial sex workers (CSW). Program evaluation revealed that prevention activities reached only 50% of the target population. The purpose of this study is to examine the barriers that Salvadoran educators faced in implementing the peer education as designed and adaptations made as a result. Between March and June 2015, 18 in-depth interviews with educators were conducted. Violence was reported as the biggest barrier to intervention implementation. Other barriers differed by subpopulation. The level of violence and discrimination calls into question the feasibility and appropriateness of peer-led interventions in the Salvadoran context and demonstrates the importance of implementation research when translating HIV prevention interventions developed in high-income countries to low- and middle-income countries.

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Evidence of the Negative Effect of Sexual Minority Stigma on HIV Testing Among MSM and Transgender Women in San Salvador, El Salvador

Cited by 70 publications

References 35 publications

Factors associated with sex work involvement among transgender women in Jamaica: a cross‐sectional study

Factors associated with sex work involvement among transgender women in Jamaica: a cross‐sectional study

Social-ecological factors associated with selling sex among men who have sex with men in Jamaica: results from a cross-sectional tablet-based survey

Combination HIV Prevention Strategy Implementation in El Salvador: Perceived Barriers and Adaptations Reported by Outreach Peer Educators and Supervisors

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