Improving HIV Care for Key Populations in the Caribbean

Key, at-risk populations in the region include men who have sex with men (MSM), bisexual men, transgender women, and sex workers. In Jamaica, HIV prevalence among MSM was estimated at 32.8%,1 as compared to an estimated prevalence of 1.8% in the general adult population in 2017.1 Among transgender women, the HIV prevalence was estimated between 25.2%2 – 52.9%3 and among female sex workers, HIV prevalence is estimated at 2%.1 Reducing stigma and discrimination toward vulnerable groups in health care settings can have a positive impact on enrollment in care, retention in care and treatment, and viral suppression of HIV in communities most heavily burdened by HIV infection.

  • Simulated Key Populations Preceptorship: Since 2016, I-TECH has implemented a novel preceptorship program called Improving HIV Care for Key Populations in the Caribbean. This initiative builds healthcare worker capacity to provide nonjudgmental, high-quality comprehensive HIV care to key, at-risk populations.As a means of increasing awareness and sensitivity among HIV health care workers, and in order to improve how they interact with and treat all patients, I-TECH designed a training that occurred in a simulated clinic setting in late 2015. Using targeted scenarios, skilled patient trainers recruited from local MSM, transgender, and sex worker communities interact with healthcare workers (clinicians and nurses). Through role-play, and in collaboration with an experienced facilitator, healthcare workers practice taking a comprehensive sexual history and performing a proper ano-genital examination with appropriate site-specific STI screening. Additionally, the healthcare worker is given the opportunity to have a frank and open discussion with the key population member—the patient-trainer—about the obstacles that influence his/her care. They may also discuss other aspects of the health care they receive, their sexual orientation and gender identity, sexual practices, mental health issues, gender-based violence, and substance abuse. I-TECH has implemented the Key Populations Preceptorship training program in Jamaica and in Trinidad, and has trained clinicians from Suriname and Barbados using this model as well. As of March 2019, 109 clinicians and nurses in the region have participated in this training. I-TECH is currently working to adapt this training model for other cadres of health workers, including HIV case managers and social workers.
  • Suriname HIV Key Populations Training: I-TECH worked with the Suriname Ministry of Health, local physicians, and community partners to develop a modular training for HIV providers in HIV care and treatment for Key Populations. The curriculum provides an overview of health concerns for key populations, and provides in-depth modules that the Ministry or other training agencies can use to target skills in sexual history taking, risk reduction and counselling, anogenital health, pelvic examination, mental health, transgender health, and KP-friendly health services. I-TECH translated the curriculum into Dutch, conducted training-of-trainers workshops that addressed both facilitation skills as well as clinical and history-taking skills, and supported the local implementation of this training in July 2019.
  • Transgender Health and Anal Health Services: I-TECH has partnered with two health facilities in Jamaica to pilot a transgender health service as well as anal health services. As part of this pilot program, I-TECH developed clinical protocols and standards of care, provided training to all staff at the health facilities, and has offered mentoring for clinicians.

1 UNAIDS. 2017. HIV and AIDS Estimates in Jamaica. Retrieved from: http://www.unaids.org/en/regionscountries/countries/jamaica
2 Logie CH, Lacombe-Duncan A, Wang Y, Jones N, Levermore K, Neil A, Ellis T, Bryan N, Harker S, Marshall A, Newman P. Prevalence and Correlates of HIV Infection and HIV Testing among Transgender Women in Jamaica. AIDS Patient Care and STDs. 2016. 30(9):416-424.
3 Figueroa JP, Cooper CJ, Edwards JK, Byfield L, Eastman S, Hobbs MM, et al. Understanding the High Prevalence of HIV and Other Sexually Transmitted Infections among Socio-Economically Vulnerable Men Who Have Sex with Men in Jamaica. PLoS ONE (10th Anniversary). 2015. 10(2): e0117686. doi:10.1371/journal.pone.0117686