Syndemic Experiences, Protective Factors, and HIV Vulnerabilities Among Lesbian, Gay, Bisexual and Transgender Persons in Jamaica
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.
KeywordsSyndemics LGBT Resilience Jamaica HIV risk Social support
We would like to thank all of the participants, peer research assistants and collaborators: Jamaica AIDS Support for Life, JFLAG: Jamaica Forum for Lesbians, All-Sexuals and Gays, Caribbean Vulnerable Communities (CVC), Aphrodite’s Pride, TransWave, and WE-Change.
We recognize funding from the Canadian Institutes of Health Research (CIHR) Institute of Gender & Health Operating Grant 0000303157; Fund: 495419, Competition 201209. Dr. Logie’s efforts were also supported by an Ontario Ministry of Research & Innovation Early Researcher Award and the Canada Research Chairs program.
Compliance with Ethical Standards
Conflict of interest
The authors declare they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Toronto and the University of the West Indies, Mona and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.UNAIDS. Modes of HIV transmission in Jamaica for 2012: recommendations for efficient resource allocation and prevention strategies. 2013.Google Scholar
- 12.Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington, DC: The National Academic Press; 2011.Google Scholar
- 13.Figueroa JP, Cooper CJ, Edwards JK, Byfield L, Eastman S, Hobbs MM, et al. 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(2):e0117686.PubMedPubMedCentralCrossRefGoogle Scholar
- 18.Gilbert L, Raj A, Hien D, Stockman J, Terlikbayeva A, Wyatt G. Targeting the SAVA (substance abuse, violence and AIDS) syndemic among women and girls: a global review of epidemiology and integrated interventions. J AIDS. 2015;69(2):S118.Google Scholar
- 22.Operario D, Nemoto T. HIV in transgender communities: syndemic dynamics and a need for multicomponent interventions. J AIDS. 2010;55:S91–3.Google Scholar
- 29.Tucker A, Liht J, de Swardt G, Jobson G, Rebe K, McIntyre J, et al. Homophobic stigma, depression, self-efficacy and unprotected anal intercourse for peri-urban township men who have sex with men in Cape Town, South Africa: a cross-sectional association model. AIDS Care. 2014;26(7):882–9.PubMedCrossRefPubMedCentralGoogle Scholar
- 32.Harriot ADJ, M. Crime and Violence in Jamaica. Inter-American Development Bank 2016.Google Scholar
- 34.UNDP. Multidimensional progress: Well-being beyond income. United Nations Development Programme. 2016.Google Scholar
- 35.Carroll A, Mendos LM. State-Sponsored Homophobia: A World Survey of Sexual Orientation Laws: Criminalisation, Protection and Recognition. 12th Edition May 2017. Geneva: International Lesbian, Gay, Bisexual, Trans and Intersex Association. 2017.Google Scholar
- 45.Friedman MS, Marshal MP, Guadamuz TE, Wei C, Wong CF, Saewyc EM, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health. 2011;101(8):1481–94.PubMedPubMedCentralCrossRefGoogle Scholar
- 52.Logie CH, Lacombe-Duncan A, Lee-Foon N, Ryan S, Ramsay H. “It’s for us–newcomers, LGBTQ persons, and HIV-positive persons. You feel free to be”: a qualitative study exploring social support group participation among African and Caribbean lesbian, gay, bisexual and transgender newcomers and refugees in Toronto, Canada. BMC Int Health Hum Rights. 2016;16(1):18.PubMedPubMedCentralCrossRefGoogle Scholar
- 58.Platt L, Wall M, Rhodes T, Judd A, Hickman M, Johnston LG, et al. 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(6 Suppl):i39–53.PubMedCrossRefPubMedCentralGoogle Scholar
- 62.Bernal G, Maldonado Molina MM, del Río MRS. Development of a brief scale for social support: reliability and validity in Puerto Rico. Int J Clin Health Psychol. 2003;3(2):251–64.Google Scholar
- 67.Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York: The Guilford Press; 2011.Google Scholar
- 68.Vandenberg RJ. Introduction: statistical and methodological myths and urban legends: where, pray tell, did they get this idea?. Thousand Oaks: Sage; 2006.Google Scholar
- 69.Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online. 2003;8(2):23–74.Google Scholar
- 70.Long JS, Freese J. Regression models for categorical dependent variables using Stata. College Station: Stata Press; 2006.Google Scholar
- 73.WHO. Jamaica: alcohol consumption, levels and patterns 2014. http://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/jam.pdf. Accessed 1 Dec 2018.
- 75.IACHR. Report on the situation of human rights in Jamaica Inter-American Commission on Human Rights. 2012.Google Scholar
- 77.Smith DE. Prevalence of intimate partner violence in Jamaica: implications for prevention and intervention. Int J Child Youth Fam Stud. 2016;7(3–4):243–63.Google Scholar
- 78.OECD. Jamaica. Organization for Economic Cooperation and Development 2014.Google Scholar
- 80.Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14(4):245–58.PubMedCrossRefPubMedCentralGoogle Scholar