"Being Safe and Being Yourself Is Two Different Things": Understanding Structural Violence and Resistance Among Sexually Diverse Youth in Kingston, Jamaica
Stigma and discrimination targeting sexually and gender diverse youth (SGDY) are pervasive global phenomena that exert a devastating impact on health and wellbeing. The limited available information indicates SGDY in Jamaica experience hate crimes, physical and sexual violence, and homelessness. This violence occurs within socio-cultural contexts of stigma and discrimination that devalue SGDY, often abetted by social and institutional exclusion. Scant research, however, has explored stigma, its health effects, and resistance strategies among SGDY in low- and middle-income countries. Intersectionality refers to the interdependent and mutually constitutive relationship between social identities and structural inequities. We employed an intersectional framework to explore stigma and agency among SGDY in Kingston, Jamaica.
Methods
Peer research assistants (n=3), who were SGDY, purposively sampled participants from local community agencies that provide health and support services for SGDY. We conducted focus groups (n=3) with: young (<24 years old) gay, bisexual and other men who have sex with men (MSM) (n=10); transgender persons (n=11); and lesbian, bisexual and other women who have sex with women (WSW) (n=6) in Kingston, Jamaica. Focus groups were digitally recorded and transcribed verbatim. Our study was guided by critical ethnography and paid particular attention to processes of social exclusion and lived experiences of inequity and personal/collective agency. We analyzed transcripts using narrative thematic analysis to identify, analyze and report themes in the data.
Results
Participants across focus groups discussed stigma towards SGDY as rooted in hegemonic masculinity and exacerbated for gender non-conforming persons. Findings revealed multi-level forms of direct and indirect violence that threatened health and survival. Direct forms of violence include: macro-level (police violence; systemic discrimination in employment, housing, health care and education), meso-level (homophobic/transphobic sexual, verbal and physical violence) and micro-level (familial rejection). Indirect forms of violence include: macro-level (criminalization of homosexuality; limited health care access), meso-level (social isolation; hegemonic masculinity) and micro-level (relationship power). Participants discussed violence impacts: mental health, in particular depression, substance use and suicidal ideation; sexual health, presenting barriers to HIV/ STI prevention; and physical health, including barriers to health care even in emergency situations. Agency was also discussed across macro (advocacy), meso (mentorship; collective mobilization) and micro (self-acceptance) domains. Important differences emerged between groups, with MSM more likely to discuss concealing their sexuality to avoid physical violence; transgender persons facing extreme poverty, homelessness, survival sex and sexual violence; and WSW reporting a lack of visibility and community. Within groups, participants discussed heightened stigma towards gender non-conforming, poor and rural SGDY.
Conclusions and Implications
Findings reveal the complexity of social and structural contexts of violence that have deleterious impacts on wellbeing among SGDY. Violence emerged across multiple sites (housing, police, community, family, health care, education), levels (micro, meso, macro) and forms of violence included latent, direct, indirect, and symbolic. The severe marginalization of SGDY and the need to hide sexuality to be safe, are not only barriers for realizing one’s potential but endanger survival. Interventions could address these multiple levels, sites and forms of violence to promote social justice, health and agency among SGDY in Jamaica.