This study estimates HIV prevalence among men who have sex with men (MSM) in Jamaica and explores social determinants of HIV infection among MSM. An island-wide cross-sectional survey of MSM recruited by peer referral and outreach was conducted in 2011. A structured questionnaire was administered and HIV/STI tests done. We compared three groups: MSM who accepted cash for sex within the past 3 months (MSM SW), MSM who did not accept cash for sex (MSM non-SW), and MSM with adverse life events (ever raped, jailed, homeless, victim of violence or low literacy). HIV prevalence among 449 MSM was 31.4%, MSM SW 41.1%, MSM with adverse life events 38.5%, 17 transgender MSM (52.9%), and MSM non-SW without adverse events 21.0%. HIV prevalence increased with age and number of adverse life events (test for trend P < 0.001), as did STI prevalence (P = 0.03). HIV incidence was 6.7 cases/100 person-years (95% CI: 3.74, 12.19). HIV prevalence was highest among MSM reporting high-risk sex; MSM SW who had been raped (65.0%), had a STI (61.2%) and who self identified as female (55.6%). Significant risk factors for HIV infection common to all 3 subgroups were participation in both receptive and insertive anal intercourse, high-risk sex, and history of a STI. Perception of no or little risk, always using a condom, and being bisexual were protective. HIV prevalence was high among MSM SW and MSM with adverse life events. Given the characteristics of the sample, HIV prevalence among MSM in Jamaica is probably in the range of 20%. The study illustrates the importance of social vulnerability in driving the HIV epidemic. Programs to empower young MSM, reduce social vulnerability and other structural barriers including stigma and discrimination against MSM are critical to reduce HIV transmission.

Background: HIV-1 drug resistance in treatment-naive patients has a significant impact on the individual patient as well as implications for the wider population. These effects are amplified in the context of resource-limited settings, which are rapidly expanding access to antiretroviral therapy. Methods: This cross-sectional survey at a single treatment site in Kingston, Jamaica was designed to identify the prevalence of HIV-1 drug-resistant mutations in chronically infected, treatment-naive patients. Mutations were identified using the Stanford HIV database algorithm and the World Health Organization (WHO) HIV Drug Resistance (HIVDR) surveillance mutations. Results: The inclusion of 103 cases in the study resulted in 79 (76.6%) amplifiable samples. Genotype analysis revealed that 12.6% (95% CI 5.3, 19.9) were identified as having clinically significant mutations, while 10.1% (95% CI 3.5, 16.7) had WHO HIVDR surveillance mutations. Conclusions: According to the WHO standard, this study population has a moderate level of HIVDR in treatment-naive patients and strongly implies the need to introduce HIVDR surveillance in Jamaica.

The goal of this study is to describe the establishment of an HIV testing and treatment programme in the Jamaican correctional system and to estimate the prevalence of HIV/sexually transmitted disease (STD) among adult incarcerated men in this country. A demonstration project was implemented by the Jamaican Department of Correctional Services and Ministry of Health in the nation's largest correctional centre. All inmates were offered HIV and syphilis testing, and a subset was offered chlamydia, gonorrhoea and trichomoniasis testing. Cross-sectional data from the project were reviewed to determine the prevalence and correlates of HIV/STD. HIV test acceptance was 63% for voluntary testers ( n = 1200). The prevalence of HIV was 3.3% (95% confidence interval [CI] 2.33–4.64) ( n = 1017) and the prevalence syphilis was 0.7% (95% CI 0.29–1.49) ( n = 967). Among the subset tested ( n = 396) the prevalence of chlamydia was 2.5% (95% CI 1.22–4.49) and for trichomoniasis it was 1.8% (95% CI 0.01–3.60), but no cases of gonorrhoea were detected ( n = 396). The prevalence of HIV was significantly higher at 25% (95% CI 13.64–39.60) for persons located in a separate section where individuals labelled as men who have sex with men (MSM) are separated. HIV/STD testing is important and feasible in Jamaica. A special focus should be placed on providing services to inmates labelled as MSM. Other Caribbean nations may also benefit from similar programmes.