Homophobia, stigma and HIV in Jamaican prisons

Success in addressing HIV and AIDS among men who have sex with men, a key population in the global epidemic, is impeded by homophobia. Homophobia as a barrier to HIV prevention and AIDS treatment is a particularly acute problem in the prison setting. In this qualitative study, we explore HIV and AIDS, stigma and homosexuality in the largest all male prison in Jamaica by conducting iterative in-depth interviews with 25 inmates. Participant narratives unveil a purposeful manipulation of beliefs related to homosexuality that impedes an effective response to HIV and AIDS both in prison and wider society. Findings indicate that homophobia is both a social construction and a tangible tool used to leverage power and a sense of solidarity in a larger political and economic landscape. This use of homophobia may not be unique to Jamaica and is an important issue to address in other low- and middle-income post-colonialist societies.     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS‐related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS‐related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti‐stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS-related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS-related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)-to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti-stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

Sex,violence and HIV on the inside: cultures of violence,denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings

To map the context of HIV in closed settings in Papua New Guinea (PNG), semi-structured interviews were undertaken with 56 prisoners and detainees and 60 key stakeholders. The nature of HIV-related risk differs for detained women and men, and reflects important gender-based issues present in PNG society more broadly. Women in detention are vulnerable to sexual violence and exploitation and at greatest risk of HIV while detained in police holding cells, where they are typically supervised by male officers, in contrast to prisons, where they have little contact with male staff. HIV risk for men in prison is associated with consensual and non-consensual sex; this risk is perpetuated by a pervasive culture of denial and institutionalised homophobia. The illegal nature of sodomy and male-to-male sex provides Correctional Services the legal grounds by which to refuse access to condoms for prisoners. Addressing HIV risk among detained men and women in PNG requires the reform of legislation, police and prison practices and an understanding of broader structural problems of gender-based violence and stigma and discrimination.     

Mosquitoes,Doorknobs, and Sneezing,Relationships Between Homophobia and AIDS Mythology Among College Students

Previous research indicated that homophobia may interfere with making realistic risk assessments regarding human immunodeficiency virus (HIV) transmission and internalizing accurate information about acquired immune deficiency syndrome (AIDS) in general. We investigated relationships among homophobia, risk assessments, and knowledge about AIDS in the college population. Data were collected as part of a larger probability sample survey. Results support the hypothesis that homophobia is positively related to the degree of risk associated with pseudorisk behaviors in the context of HIV infection. Furthermore, results indicate that homophobia is also related to several real risk factors. In general, the greater a student's homophobia, the less likely he or she was to make realistic risk assessments. Results also show that the degree of homophobia of respondents varied on the basis of specific knowledge about AIDS and the interaction of specific knowledge with gender. Discussion focuses on homophobia as a fuel for AIDS mythology with implications for interpersonal communication with people with HIV/AIDS and for developing AIDS prevention campaigns for the college population.     

Homosexuality, seropositivity, and family obligations: perspectives of HIV-infected men who have sex with men in China

The HIV epidemic has had major impact on men who have sex with men in China. Most current studies view male-to-male sex as a behavioural dimension or variable affecting HIV infection, paying little attention to the socio-cultural meanings of homosexuality and their impacts on men's experiences with HIV/AIDS. This oversight has impeded understanding of the health practices of this population. Based on a qualitative study of experiences of Chinese people living with HIV/AIDS, this paper explores the complex processes in which men who have sex with men struggle and negotiate with their sexuality, family obligations, and this disease. To facilitate Chinese men who have sex with men in responding effectively to HIV and AIDS, researchers and practitioners should take into account a wide range of contextual factors including desired gender roles, family obligations, homophobia, and HIV-related stigma that contribute to current constructions of 'homosexuality' in China.     

Precursive depression among HIV infected AIDS caregivers over time

This study examines depression among HIV infected AIDS caregivers, documenting and explaining variation in health within a stress proliferation framework. Longitudinal data for 376 HIV- and HIV+ caregiving men who self-identify as gay are analyzed to establish how changes in depression are influenced by care-related stressors and by being a member of the gay, HIV-affected community. This research identifies the mechanisms by which the caregiver stress process unfolds distinctively among caregivers with AIDS-related health problems, in comparison to HIV- caregivers. Three waves of data are analyzed using longitudinal multiple regression models. Among HIV infected caregivers, mental health is affected by deteriorating health, perceptions of AIDS alienation/stigma, internalized homophobia, role overload, and financial worry. For both groups, depression is a function of social constriction and AIDS-related bereavement. The precursive nature of caregiving among these HIV infected men may magnify the stress of being in poor health, gay, and stigmatized.     

驻马店市新羁押劳教人员HIV感染率估计高危人群HIV综合感染率

目的了解驻马店市劳教人员艾滋病病毒(HIV)感染的相关行为信息,为类似人群开展艾滋病干预措施提供依据。探讨以此类人群艾滋病感染率替代各类高危人群综合艾滋病感染率的可行性。方法对2010年1月至9月间所有监狱3个月内新入监的劳动改造人员进行HIV检测和问卷调查。与我市高危哨点检测出的感染率进行比较。结果在1 226名新入监劳教人员中检测出HIV抗体阳性11例,感染率为0.89%,其中3例有献血史,3例有吸毒史和嫖娼史,2例吸毒,2例性乱,1例无吸毒、无性乱史。结论劳动改造人员成分比较复杂,卖淫嫖娼吸毒等高危行为比较常见,本次调查显示,新入监劳动改造人员0.89%的艾滋病感染率与我市高危人群(吸毒、暗娼、男男同性恋3类人群)综合的艾滋病感染率0.72%非常接近。提示我们以此类人群艾滋病感染率替代各类高危人群综合艾滋病感染率具有可行性。     

HIV/AIDS and homophobia: Subtle hatreds,severe consequences and the question of origins

This paper argues that the relationship between homophobia and HIV/AIDS is not as direct as is often assumed. This argument is pursued through an examination of the situation of gay men in Australia, a country where the HIV epidemic is largely confined to gay men, and Bangladesh, a country and culture where sex between men does not conform to categories of human sexuality privileged in Western theory. Both of these countries reveal something different about cultures of sex between men, which provides a counterpoint to the often compelling and usually pervasive accounts of HIV-related discrimination that are derived particularly from North America. The paper concludes with a plea that as efforts are geared up to fight the HIV pandemic in Asia and the Pacific, researchers, planners and practitioners become more critical of the conceptual tools they rely on in thinking about HIV/AIDS and human sexual activity, so that it is possible to mobilize (and do less damage to) local cultures of sexuality.     

Male prisoners and HIV prevention: a call for action ignored

US prison inmates are disproportionately indigent young men of color. These individuals are severely affected by HIV/AIDS, largely owing to the high-risk behavior that they engage in prior to incarceration. Researchers and practitioners have issued a call for the importance of offering HIV prevention services in prison settings. However, this call has largely been ignored. In this article, we outline reasons why these recommendations have been largely ignored, discuss innovative HIV prevention programs that are currently being implemented in prison settings, and offer recommendations for securing support for HIV prevention services in correctional settings.     

Jails and AIDS. Risk factors for HIV infection in the prisons of Madrid

The spread and risk factors for HIV infection were studied in 288 men and 95 women at the prisons of Carabanchel and Yeserias, Madrid. These men and women requested care at the AIDS prevention program in the jails of Madrid, from April to December 1987. Among the men studied at Carabanchel, 55% were positive to HIV (77% seropositivity among intravenous drug users, IVDU). Tattooing (OR = 2.8), and number of times in prison (OR = 4.5 comparing those who had been 8 or more times in prison with those who had been in prison only once) were independent risk factors for infection, after controlling for IVDU. No association was found between seropositive status to HIV and reported anal intercourse. Among the women studied at Yeserias, the proportion of HIV seropositive women was 26% (70% of the IVDUs were seropositive). Tattooing, number of times in prison, history of prostitution and history of syphilis were associated with HIV infection. When controlling for IVDU, number of times in prison and history of prostitution were not independent risk factors for infection. These data indicate that there is a need for control measures to avoid further spread of the HIV infection among the inmate population, in particular through the use of contaminated needles while in prison.     

AIDS education and incarcerated women: a neglected opportunity

Attitudes and perceptions about health, AIDS, and the need for AIDS education were explored among inmates in a women's prison in the southeastern U.S. Forty short-term inmates participated in a series of focus group interviews. A separate sample of sixteen women completed a 103-item questionnaire. Focus group participants expressed concern about AIDS within prison, sexual activity between inmates, and the institution's policy of housing seropositive women with the general inmate population. Close to half (44%) of the survey respondents believe that they were likely to be exposed to HIV in prison; most (81%) felt that AIDS education programs should discuss female homosexual activity, and nearly all respondents (94%) felt that inmates should be given an HIV antibody test upon entering prison. The study's findings confirm the need for tailoring AIDS education and prevention activities for incarcerated women.     

AIDS deaths, HIV infections declining among prisoners

The Justice Department has announced that the overall prevalence rate of HIV among the nation's prisoners has stabilized, and the number of deaths attributed to AIDS has declined. Although there have been substantial improvements in health care in prisons, much work remains to be done in preventing and treating infections. The report states there is a strong link between HIV infection and inmate's substance abuse before imprisonment. Women in prison have a higher HIV infection rate than men, and African-Americans and Hispanics continue to have higher rates than whites. The Justice Department report outlines concerns facing correctional facilities including prevention programs, discharge planning, and testing in the federal and state prison systems to control the spread of HIV. Charts profile HIV in the nation's prisons, including trends, geographic prevalence, and infection rate by race, ethnicity, and gender.     

Activists at gathering plead with Clinton to take the lead

A speech delivered by President Bill Clinton at the December 6, 1995 White House Conference on HIV/AIDS was met with enthusiasm and optimism by those attending. President Clinton predicted that a cure for AIDS and a vaccine to prevent further infection would be developed. The President focused on his administration's accomplishments and efforts related to the epidemic, including an accelerated drug-approval process. He also condemned homophobia and discrimination against people with HIV. Conference attendees were disappointed, however, that the President did not support government-sponsored needle distribution and exchange programs. Clinton announced three new initiatives: creating a special working group to coordinate AIDS research throughout the Federal government; convening public health experts to develop an action plan that integrates HIV prevention with substance abuse prevention; and launching a new effort by the Justice Department to ensure that health-care facilities provide equal access to people with HIV and AIDS.     

Sexual stigma and sympathy: attitudes toward persons living with HIV in Jamaica

As the number of persons living with HIV continues to increase in Jamaica, attitudes and values become more important. This study aimed to examine the attitudes of university students in Jamaica toward persons living with HIV, including homosexual men, heterosexual men, women sex workers, other women, and children. One thousand two hundred and fifty-two students were surveyed between June 2001 and February 2002 using a 193-item questionnaire measuring a variety of HIV-related knowledge, attitudinal and behavioural items. Less than half of students reported sympathetic attitudes toward homosexual men or women sex workers living with HIV while a majority reported generally sympathetic attitudes toward heterosexual men and non-sex worker women living with the disease. Predictors of sympathy varied by target group. Male students were significantly less likely to report sympathy for homosexual men than for any other group. Spirituality was associated with sympathy for homosexual men and women sex workers, but not for the remaining two groups. Findings suggest that levels of negative attitudes are high in Jamaica and warrant attention to both individual and societal-level actions and interventions. In addition, messages and interventions must be targeted, recognizing both the differences in level of sympathy expressed toward different groups and predictors of sympathy across the groups.     

Collaborative research to prevent HIV among male prison inmates and their female partners.

Despite the need for targeted HIV prevention interventions for prison inmates, institutional and access barriers have impeded development and evaluation of such programs. Over the past 6 years, the authors have developed a unique collaborative relationship to develop and evaluate HIV prevention interventions for prison inmates. The collaboration includes an academic research institution (the Center for AIDS Prevention Studies at the University of California, San Francisco), a community-based organization (Centerforce), and the staff and inmate peer educators inside a state prison. In this ongoing collaboration, the authors have developed and evaluated a series of HIV prevention interventions for prison inmates and for women who visit prison inmates. Results of these studies support the feasibility and effectiveness of HIV prevention programs for inmates and their partners both in prison and in the community. Access and institutional barriers to HIV intervention research in prisons can be overcome through the development of collaborative research partnerships.     

'It's my inner strength': spirituality, religion and HIV in the lives of young African American men who have sex with men

Young black men who have sex with men account for 48% of 13-29-year-old HIV-positive men who have sex with men in the USA. It is important to develop an effective HIV prevention approach that is grounded in the context of young men's lives. Towards this goal, we conducted 31 interviews with 18-30-year-old men who have sex with men in the San Francisco-Oakland Bay Area. This paper examines the roles of religion and spirituality in men who have sex with men's lives, which is central in the lives of many African Americans. Six prominent themes emerged: (1) childhood participation in formal religious institutions, (2) the continued importance of spirituality among men who have sex with men, (3) homophobia and stigmatisation in traditional black churches, (4) tension between being a man who has sex with men and being a Christian, (5) religion and spirituality's impact on men's sense of personal empowerment and coping abilities and (6) treatment of others and building compassion. Findings suggest that integrating spiritual practice into HIV prevention may help programmes be more culturally grounded, thereby attracting more men and resonating with their experiences and values. In addition, faith-based HIV/AIDS ministries that support HIV-positive men who have sex with men may be particularly helpful. Finally, targeting pastors and other church leaders through anti-stigma curricula is crucial.     

Influence of socio-cultural context on risk perception and negotiation of protection among poor homosexual males on the Peruvian coast

This paper focuses on risk, conceived not as an individual action, but considering its social dimension, analyzing the various forms in the socio-cultural context related to internalized homophobia and hegemonic gender norms that allow barriers to be constructed in risk perception. Such barriers hinder negotiation and protection among homosexual men that have adopted a female gender identity, living in low-income barrios of Lima and Trujillo, Peru. Risk perception is analyzed on the socio-cultural plane, allowing one to explain the limited negotiating capacity of this population, even though they have extensive knowledge of HIV/AIDS and its consequences.     

Alternatives to current HIV/AIDS policies and practices in South African prisons

Prisoners in South Africa face problems of overcrowding, violence and poor nutrition. Added to this burden in recent times is the increased threat from HIV. The HIV epidemic has been relatively late in coming to South Africa but infection rates are now 20% in the adult population. However, there is no data available on the level of HIV infection in the prison population. Overseas studies suggest that the characteristics of prisoners place them at much greater risk of HIV infection. Factors which contribute to increased levels of HIV infection include poor health care facilities, lack of condoms and lack of disinfectants. Current policies and practices on HIV in prison attempt to balance the constraints of limited resources with the need to preserve prisoner human rights. The outcomes include: mass testing not freely available, HIV education is limited, and early release of prisoners with advanced AIDS is not allowed. Constraints on the implementation of effective HIV prevention strategies include: bureaucratic inefficiency, lack of resources, and a reluctance by prison authorities to address the issue of HIV in prison. These problems can possibly be overcome by addressing the issue from both management and prisoner perspectives. On the management side, increased resources, increased training of prison officials, and increased political commitment to address the issue are required. Outside partnerships are probably required for an effective response. Prisoners require better nutrition, better living conditions, better health care, freely available condoms and disinfectants.