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Preventatives:

The WHO has recommended these policies are put into place:

1.     Universal access to SRH and HIV information and services for all regardless of age, sexual orientation, social and economic status and political affiliation.

2.     All Jamaicans must have access to comprehensive, age appropriate, context specific, information on SRH and HIV.

3.     Affirm human rights of key populations and ensure comprehensive access to prevention information and services

4.     Ensure consistent supply of quality HIV prevention commodities

-Positive Health, Dignity, and Prevention (PHDP) is an overarching term used for HIV prevention interventions among people living with HIV (PLHIV). Other terms that have been known to be used interchangeably include positive prevention, prevention with positives, prevention by positives, and prevention for positives. PHDP activities focus on the achievement of four key goals. These include: “(1) keeping PLHIV physically healthy; (2) keeping PLHIV mentally and psychologically healthy; (3) preventing transmission of HIV; and (4) involving PLHIV in HIV prevention activities, programme design, implementation and monitoring, leadership, and advocacy.”36

A comprehensive policy on sexual and reproductive health and rights including provisions for women living with HIV on freedom from sexual violence, forced abortion, and sterilization among other things should be developed and implemented.

§ Gender-sensitive HIV training should be provided for health care providers, social workers, teachers, and judicial and law enforcement officers.

§ Special initiatives aiming at the economic empowerment of women especially those living with HIV and AIDS should be implemented.

§ Measures should be taken to adopt and implement a national strategy on gender and HIV to address sexual diversity among women and men and all factors that increase HIV vulnerability among women and men, and to ensure their access to comprehensive sex, health, and HIV education, and prevention, care, and support services

§ Integrate a rights-based approach to sexuality, gender mainstreaming, and empowerment in the national development plan and National HIV/AIDS Strategic Plan.37

In addition:

·       §  Women should have the right to HIV-related services that are non-coercive and respectful of

privacy, confidentiality and autonomy―including the right to consent or refuse services without

being required to consult any other person or family member.

·       §  Health Care Providers should address the overall health and specific psychosocial needs of

women, particularly, older women and young girls, in the provision of counselling and other assistance.

Initiatives:

In 2013, the National HIV/STI Programme was integrated into the National Family Planning Board (NFPB) to create one executive agency with responsibility for sexual and reproductive health. The National Family Planning Board, empowered by the National Family Planning Act (1970), is the Government agency responsible for preparing, implementing, coordinating, and promoting sexual and reproductive health services in Jamaica.

National Integrated Strategic Plan for Sexual and Reproductive Health and HIV (2014 – 2019) Implemented

The plan serves as stakeholders’ guide to the implementation of the national response to HIV/AIDS and Family Planning in Jamaica. The Plan outlines five priority areas: 1) Prevention and SRH Outreach; 2) Universal Access to Treatment, Care and Support and SRH Services; 3) Enabling Environment and Human Rights; 4) Monitoring and Evaluation of HIV, Family Planning and Sexual Health Response and 5) Sustainability, Governance and Leadership. Key targets include:

o Reduce by half, the number of new HIV infections by 2019

o Reduce the number of HIV related deaths by 25% by 2019

o Increase coverage of ARV treatment for PLHIV to 65% by 2019

o Increase to 90% the proportion of PLHIV on ART one year after initiating therapy

National HIV/STI programme has been working on:

- Increased strategic investments in the HIV response

- Improved HIV Testing

­- Improved access to treatment and care for PLHIV

- Improved Data Collection on HIV

- Mother to child transmission of HIV at elimination level

- Expanded HIV and AIDS Programming for youth

- Social and economic impacts of HIV addressed

- Improving enabling environment through legislative and policy reform

Underlying causes of aids/Stigmatism/cultural expectations:

This is due to inadequate investigation and reporting of cases as well as unwillingness among men who engage in sex with other men to disclose their sexual practices. Of the total number of men reported with HIV in 2015, 5.7% (35) were identified as homosexual and 3.2% (20) identified as bisexual. In 2015, a total of 28 PLHIV (2.2%) reported being a sex worker, with the sex breakdown among them showing 64% (18) females to 36% (10) males.

Data on the HIV epidemic in Jamaica acknowledge the main risk factors fuelling the epidemic as: multiple sexual partners17; history of STIs, crack/cocaine use, and sex with sex workers. ‘No high-risk behaviour’ was reported for a significant proportion (12%) of HIV cases and this may represent persons who have one sex partner who was HIV infected by another partner.18

Other notable high-risk behaviours that are integrally linked to the main risk factors are insufficient condom use, early sexual debut, and transactional sex. Some of these factors are expanded further based on their ability to erase gains already made in the response to the epidemic.

Multiple Sexual Partners (MSP): This is the most immediate cause of new HIV infections and significantly correlates with the majority of drivers of the epidemic (MoT 2012, KAPB 2012). Implicit in the practice is the prevailing cultural norms about manhood and as such MSP is tacitly accepted in the Jamaican socio- cultural dynamic. Men are more likely to have multiple sexual partners than women – males report on average 6.2 women whilst women report having 2.2 (KAPB 2012). The Knowledge Attitude Practice and Behaviour (KAPB) Survey 2012 reported that 41% of sexually active persons aged 15 - 49 years who had sex in the last 12 months had sex with two or more partners. The data shows that 60.5% of males reported having multiple sexual partners compared to 19.4% of female respondents reporting having multiple sexual partners.

Other: Among the other major risk factors driving the HIV epidemic in Jamaica are the following key underlying factors:


 * §  Stigma and discrimination: Deeply entrenched issues around stigma (both internal and external) and discrimination continue to pose a serious threat to the control of the HIV epidemic.
 * §  Homophobia: Gender norms relating to sexuality and masculinity tend to privilege heterosexual relations. MSM may be reluctant to get tested due to stigma and discrimination, which is often caused by attitudes against homosexuality and/or bisexuality. Such attitudes reflect an emphasis

·       on heterosexual sex as a norm.20 As a result, infected men may continue to have unprotected sexual relations and unknowingly transmit the infection to their partners (male or female). Poverty: Overall, unemployment in Jamaica is far higher among women in all age categories than males and there is a preponderance of women in the lower rungs of the labour market. For women and girls, poverty may increase vulnerability to HIV infection and force them to exchange unprotected sex for food, money, school fees or other basic needs.

·       Physiological, social, cultural and economic circumstances: These have a disproportionately negative impact on the ability of key population and vulnerable groups to adopt protective behaviours and access HIV and SRH services;

Gender inequity: Women, particularly adolescent girls, continue to be disproportionally affected by HIV in Jamaica. Many sexual and reproductive health problems are directly linked to gender inequity, including unintended pregnancies, STIs, gender-based violence and maternal mortality. Gender inequalities exacerbate women and girls’ physiological vulnerability to HIV and block their access to HIV services

·       Gender norms and roles:21 Gender norms and gender stereotypes affect HIV. Gender norms and cultural practices relating to sexual behaviour put men, women, boys and girls at risk and include the pressure to prove womanhood through early pregnancies and multiple partnerships.

Gender based violence: Gender based violence (GBV)22 increases social vulnerability and is most often perpetrated by males against females. Cultural attitudes that disempower women and promote sexual violence as a reflection of masculinity limit safer sex negotiation for condom use and the refusal of sex, due to fear of violence (Kempadoo, 2006).