Police Harassment and Associations with HIV Vulnerabilities Among Men Who Have Sex with Men and Transgender Women in Jamaica: A Call to Action for International Social Work

Background and Purpose: Criminalization of same-sex sexual practices constrains health and human rights for sexually and gender diverse people. Criminalization is a structural driver of HIV that indirectly influences HIV vulnerability through multiple pathways, including limiting HIV prevention and care programs for gay, bisexual and other men who have sex with men (MSM) and transgender women, increased economic insecurity that contributes to survival sex work, and a lack of human rights protection that elevates exposure to community and police violence. Limited research has linked human rights violations targeting MSM and transgender women to HIV vulnerabilities in middle-income contexts where same-sex practices are criminalized, such as Jamaica. We examined factors associated with police harassment due to sexual orientation or transgender identity among MSM and transgender women in Jamaica. We hypothesized that police harassment would be associated with social marginalization and increased vulnerabilty to HIV acquistion.

Methods: We conducted a cross-sectional survey using chain referral sampling with MSM and transgender women in Kingston, Ocho Rios and Montego Bay, Jamaica. We hired and trained MSM and/or transgender identified peer research assistants to administer the survey. We examined health (e.g. HIV status), individual-level (e.g., age), interpersonal-level (e.g., violence), and structural-level (e.g., food insecurity) factors associated with ever experiencing police harassment. Logistic regression was used to estimate crude and multivariable-adjusted odds ratios and 95% confidence intervals for the odds of ever experiencing police harassment among MSM and transgender women.

Results: Among MSM participants (n=556; median age 24, IQR: 22-28) 13.5% (n=67) were HIV-positive, and among transgender women participants (n=137; median age 24, IQR: 15-44), 25.2% (n=26) were HIV-positive. One-fifth (n=124, 22.3%) of MSM, and 43.8% (n=60) of transgender women, reported ever experiencing police harassment due to their sexual orientation and/or gender identity. Approximately half of MSM (n=266; 47.9%) and trans women (n=82; 59.9%) reported experiencing current food insecurity. One-third (n=182) of MSM and half (n=71) of transgender women reported sex work in the past year. Among MSM, the adjusted odds ratio (AOR) of ever experiencing police harassment were higher for participants who were: HIV positive (AOR: 1.85, 95% CI: 1.01-3.38), sex workers (AOR: 2.47, 95% CI: 1.54-3.96), food insecure (AOR: 2.44, 95% CI: 1.51-3.94) and did not have a regular healthcare provider (AOR: 1.66, 95% CI: 1.02-2.71). Among transgender women, the adjusted odds of ever experiencing police harassment were higher for participants who were HIV-positive (AOR: 3.11, 95% CI: 1.06-9.12) and reported higher levels of enacted (e.g. overt) transgender stigma (AOR: 1.68, 95% CI: 1.26-2.07).

Conclusions and Implications: Our study highlights widespread police harassment among MSM and transgender women in Jamaica that is associated with HIV vulnerabilities. MSM and transgender women who experienced social and economic marginalization (e.g. sex workers, HIV-positive) reported higher rates of police harassment. Social work researchers and practitioners can collaborate with MSM and transgender communities in Jamaica to develop social change strategies. Interventions can address police practices, stigmatizing societal attitudes, and legal protections from discrimination in order to promote health and human rights for MSM and transgender women in Jamaica.