S. Sutherland , L. Byfield, N. Cooper National HIV/STI Programme, Ministry of Health

1. S. Sutherland, L. Byfield, N. Cooper National HIV/STI Programme, Ministry of Health Jamaica, West Indies One-to-One Risk Reduction Conversations: a Mechanism to Improve Risk Perception Among Jamaica's Men Who Have Sex with Men Population

2. Background • Population: 2.6 million • HIV Prevalence: 1.7% • HIV Prevalence among MSM: 31.8% (2007) • Buggery (anal sex) illegal in Jamaica

3. Issues • In a 2007 prevalence and behavioural survey among 201 MSM from 3 parishes the following risk behaviours were reported : - 27.4% reported having 2 or more male partners in past 4 weeks - 25.9% had a new male partner in past 4 weeks - 28.8% had a female partner in past 4 weeks - 15.9% reported that they were presently living with a female sexual partner - 33.8% had 2 or more female partners in past 12 months - Of the 64 respondents that tested HIV+ 73% reported playing the role of recipient in the past 12 months - Of the 102 respondents with symptoms of an STI 39.2% reported not going anywhere for treatment

4. Objective • To provide a non-judgemental environment where risk behaviours could be assessed • To increase the risk perception of MSM and therefore impact on their risk behaviour one-to-one counseling sessions are included as part of the MSM empowerment programme

5. MSM BCC Intervention • over 6 months (30 contact hrs) MSM participants are placed in small groups and each individual is required to attend a workshop once a month where they receive VCT, HIV/STI Education, Condom Skills, and Risk Assessment, remedial education, and skills training. • Each MSM participant is provided with one-to-one counseling opportunities with the workshop facilitators to discuss their individual specific risk behaviours and their life goals.

6. MSM Intervention Model

7. One to One Conversation Topics • Demographics (age, living arrangements) • Age and circumstances of first sexual encounter • Sexual history - condom and lube use or barriers to use - no. and gender of partners - Sexual roles – top or bottom • Testing history and partner testing • Disclosure of HIV results • Homophobia – at home, work, church, school • Risk assessment and risk reduction • Disclosure of sexual orientation

8. Findings (Qualitative data) Respondent #1: • 18 years old, first and only male sexual partner is best friend with whom he continues to have a relationship, began having sex at 14, has a steady girlfriend who is unaware of sexual orientation, does not use condoms or lubricant with either partner, plays either sexual role, first HIV test done through empowerment workshop • Believes he is at low risk for contracting HIV because he does not have sex with male or female partner regularly

9. Qualitative data Respondent #2 • 30 years old, multiple partners, concurrent relationships, engages in transactional sex with males, resides in homophobic community, last relationship with a female was 2 years ago, uses condoms occasionally, uses vaseline or baby oil as lubricant, prefers to be a bottom due to the fact that he is looking for partners willing to provide financial support • Believes risk is low with female partner and married men therefore targets them for transactional sex

10. Qualitative data Respondent #3 • 23 years old, family aware of sexual orientation and are supportive and non-judgemental, however resides in homophobic community, has 2 main partners, does not purchase lubricants because of stigma, has not had a relationship with a female since first homosexual experience • Believes that risk is low due to the fact that he provides financial support to both partners

11. Lessons Learned • Due to homophobia, Jamaica’s MSM have limited opportunities to discuss their individual sexual practices, and this skews their risk perception because they deny and ignore the risk behaviours not only to friends and family for fear of repercussions but also to themselves. • MSM do not see anal sex as a greater cause for concern than other types of penetrative sex

12. Lessons Learned • Empowerment sessions engendered cooperation and trust and increased access to population • MSM are important factor in HIV epidemics: • Concurrent and multiple partnerships • Bridge to general population • Wide-reaching networks • Poor health seeking behaviour • Perceive that there is limited access to health information and services • Use and awareness of other risk reduction options apart from condoms use was low and not seen as viable options

13. Other key findings • A 2010 Behavioural survey also corroborated the need for one-to-one counseling to address the poor risk assessment among the community. • e.g. - Condom use with male and not female sexual partners - No condom use with effeminate MSM - Females or femininity viewed as low risk

14. Feedback/ Achievements • “Good to be able to talk with someone honestly about my sexual struggles.” • “It was like relating to a father and mother.” • “It is good to know that straight persons actually care about MSM issues.” • 100% testing for HIV and other STIs • Establishment of MSM friendly clinical services which are accessible, accepted and supported

15. Next steps • Increase the number of one-to-one risk reduction sessions to gauge the improvement in risk perception • Expand program to reach MSM in other socio-economic brackets and men who do not self-identify (e.g. parolees) • Need to conduct further research on the impact of homophobia on risk perception of Jamaica’s MSM

16. THANK YOUFor more information • National HIV/STI programme website: www.jamaica-nap.org • Sannia sutherland, Prevention Technical Officer, Jamaica sutherlands@moh.gov.jm • Lovette Byfield, Director HIV Prevention, Jamaica byfieldl@moh.gov.jm