Improving HIV Care for Key Populations in the Caribbean

In 2015 I-TECH designed and launched a novel preceptorship program called Improving HIV Care for Key Populations in the Caribbean. This initiative is aimed at building clinicians’ capacity to provide nonjudgmental, high-quality comprehensive HIV care to key, at-risk populations.

Key, at-risk populations in the region include men who have sex with men, bisexual men, transgender women and sex workers. HIV rates vary according to country and population. In Jamaica, a 2015 study found that HIV prevalence among men who have sex with men was 31.4%[1], as compared to an estimated prevalence of 1.6% in the general adult population in 2015.[2] Among transgender women, the HIV prevalence was estimated between 25.2%[4] 52.9%[1] and among female sex workers, HIV prevalence is estimated at 4.1%.[3-4]

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 introduced training that occurs in a simulated clinic setting. Using targeted scenarios, skilled patient trainers recruited from local MSM, transgender, and sex worker communities interact with healthcare workers (clinicians and nurses). Through this role play, and in collaboration with an experienced clinical or nurse facilitator, healthcare workers practice taking a comprehensive sexual history and performing a proper ano-genital examination with appropriate site-specific STD screening. They also practice individual risk assessment and risk reduction counseling. The healthcare worker is afforded 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.

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.

  1. 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
  2. UNAIDS. 2015. HIV and AIDS Estimates in Jamaica. Retrieved from: http://www.unaids.org/en/regionscountries/countries/jamaica
  3. Figueroa JP, Bailey A. (2015) A framework for sexual decision-making among female sex workers in Jamaica. Archives of Sexual Behavior. 2015 Apr 3. doi:10.1007/s10508-014-0449-1
  4. 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.