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

ABSTRACT

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.

KEYWORDS:

• MSM
• stigma
• Jamaica
• HIV risk
• HIV prevention

Responsible Editor Maria Emmelin, Umeå University, Sweden

Responsible Editor Maria Emmelin, Umeå University, Sweden

Acknowledgments

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), and Aphrodite’s Pride.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The Research Ethics Board at the University of Toronto and the University of West Indies, Mona Campus, provided research ethics approval for this study.

Paper context

Men who have sex with men (MSM) who sell sex often experience criminalization, stigma, and violence that elevate HIV risk. Limited research has examined the experiences of this population in contexts where both same-sex practices and sex work are criminalized. Our study addresses these knowledge gaps by examining social and structural factors associated with selling sex among MSM in Jamaica, including stigma and economic insecurity. The findings inform multi-level policy and practice intervention approaches.

Additional information

Funding

This research was funded by the Canadian Institutes of Health Research (CIHR) Operating Grant 0000303157; Fund: 495419, Competition 201209. CHL is supported by an Ontario Ministry of Research and Innovation Early Researcher Award from the Ministry of Research, Innovation and Science.

Notes on contributors

Carmen H. Logie

CHL was the nominated principal investigator, conceptualized the study and led manuscript writing. KL, AM, and PAN were study investigators and contributed to study design. KL, NJ, TE, AN, and NB contributed to developing the survey instrument and conducted data collection. KK led data analysis, CHL contributed to data analysis. ALD and KK contributed to manuscript writing. AM, NJ, and PAN provided edits and feedback. All authors have read and approved the final manuscript.