The HIV epidemic in Jamaica: a need to strengthen the National HIV Program

Exploring socio-economic dimensions in HIV research: a comprehensive bibliometric analysis (1992-2024)

The socio-economic burden of HIV infection remains a critical global health concern. This study was conducted to perform a comprehensive bibliometric analysis of the socio-economic burden of HIV infection, highlighting research trends, collaboration networks, and the evolving focus on social determinants of health over the past 32 years. A systematic search was conducted in Scopus and Web of Science Core Collection databases, covering publications from 1992 to 2024. The analysis was performed using RStudio and Biblioshiny, focusing on 1,054 studies from 422 publications. This study revealed a steady annual growth rate of 16.72% in publications on the socio-economic burden of HIV from 1992 to 2024, with the USA and Canada leading in contributions. The University of Toronto emerged as the top institution, while 'social determinants of health' and 'HIV infections' were identified as pivotal research themes. Collaboration networks were predominantly among high-income countries, with limited engagement from high-burden regions like sub-Saharan Africa. Key journals, such as AIDS and Behavior, were identified as central to advancing the field. Thematic analysis highlighted a shift from biomedical to socio-economic factors, emphasizing the need for equitable global collaboration and research addressing disparities in HIV management. This comprehensive analysis provides valuable insights into the evolving landscape of HIV socio-economic burden research, emphasizing the need for increased collaboration with high-burden regions and a continued focus on addressing social determinants of health in HIV management.

A closer look: factors impacting HIV durable viral suppression among a cohort of clinic attendees in Trinidad & Tobago

BACKGROUND

In Trinidad and Tobago, high HIV prevalence among key populations necessitates studying factors that impact durable viral suppression (DVS), crucial for effective HIV management and reducing transmission among at-risk networks. This study investigates these factors using clinical data from a major HIV care clinic in the Caribbean.

METHODS

A retrospective analysis of 533 adult people with HIV (people) at MRFTT from 2017 to 2021 assessed the proportion achieving DVS, defined as a sustained viral load <200 copies/ml over one year. Initial univariate analysis characterized individuals with DVS, followed by bivariate analysis to explore socio-demographic differences. Significant variables from bivariate analysis were examined in a regression model to identify DVS covariates.

RESULTS

The average age of the sample was 45 years (SD = 10.88), with 52.0% male and 72.1% of African descent. 31.5% achieved durable viral suppression (DVS). Those with DVS were predominantly women (54.1%), older (mean age 45, SD = 11.32), with more frequent clinic visits over five years (mean = 101, SD = 33.26). Regression analysis showed that women (OR = 1.43, 95% CI 0.99-2.07), individuals on long-term antiretroviral therapy (ART) (>5 years) (OR = 1.66, 95% CI 1.03-2.66), and those with extended clinic enrolment (>5 years) (OR = 1.82, 95% CI 1.08-3.06) had higher odds of achieving DVS.

CONCLUSIONS

Only a third of the study sample achieved DVS, with men less likely to reach this goal. Lesser engagement in care correlated with lower DVS rates. Further research into social and structural barriers to clinic attendance, particularly among younger men, is recommended.

Intersecting Stigma and the HIV Care Cascade: Qualitative Insights from Sex Workers, Men who have Sex with Men, and Transgender Women Living with HIV in Jamaica

In Jamaica, stigma experiences of sex workers (SW), gay men and other men who have sex with men (MSM), and transgender women living with HIV remain understudied. To address this gap, we explored experiences of stigma and linkages with the HIV care cascade among key populations living with HIV in Jamaica, including cisgender women SW, MSM, and transgender women. This qualitative study involved n = 9 focus groups (FG), n = 1 FG per population living with HIV (SW, MSM, transgender women) in each of three sites (Kingston, St. Ann, Montego Bay). We also conducted key informant (KI) interviews. We applied thematic analysis informed by the Health Stigma and Discrimination (HSD) Framework. FG participants (n = 67) included SW (n = 18), MSM (n = 28), and trans women (n = 21); we interviewed n = 10 KI (n = 5 cisgender women, n = 5 cisgender men). Participant discussions revealed that stigma drivers included low HIV treatment literacy, notably misinformation about antiretroviral therapy (ART) benefits and HIV acquisition risks, and a lack of legal protection from discrimination. Stigma targets health (HIV) and intersecting social identities (sex work, LGBTQ identities, gender non-conformity, low socio-economic status). Stigma manifestations included enacted stigma in communities and families, and internalized stigma-including lateral violence. HIV care cascade impacts included reduced and/or delayed HIV care engagement and ART adherence challenges/disruptions. Participants discussed strategies to live positively with HIV, including ART adherence as stigma resistance; social support and solidarity; and accessing affirming institutional support. In addition to addressing intersecting stigma, future research and programing should bolster multi-level stigma-resistance strategies to live positively with HIV.

Reduction in time to viral suppression among persons living with HIV in Jamaica between 2017-2019

INTRODUCTION

HIV viral suppression is important for effective treatment and for reducing new infections. In 2019, only 66% of persons on antiretroviral treatment (ART) in Jamaica were virally suppressed. We aim to compare time to viral suppression by ART initiation year and type of treatment site to understand the implications for programming.

METHODS

We assessed time to viral suppression among 4560 persons who received viral load testing either pre or post ART initiation from 2017-2019. We used descriptive statistics and Kaplan-Meier estimates to compare survival curves by ART year (2017, 2018, 2019), sex and type of treatment site (public and non-governmental organizations). Persons were censored if suppression was not achieved. Mixed effects Cox regression was used to determine the effect of covariates on the likelihood of viral suppression. We report hazard ratios and 95% confidence intervals.

RESULTS

Pre-ART viral load testing decreased from 36% in 2017 to 30% in 2019. For post-ART viral load tests, approximately 78% (n = 1589) of persons achieved suppression, 51% (n = 809) were female and 86% (n = 1341) used a public treatment site. The median time to suppression decreased by 3 months from 2017 to 2019. The likelihood of suppression was almost 2 times greater in 2018 (HR = 1.56, CI = 1.39-1.75) and 3 times greater in 2019 (HR = 3.17, CI = 2.76-3.64) compared to 2017. NGO treatment sites were also significantly associated with the likelihood of viral suppression compared to public sites.

CONCLUSION

Pre-ART viral load testing and the time to viral suppression decreased over three years. Initiating ART after 2017 and early use of NGO treatment sites were found to significantly increase the likelihood of achieving suppression. This demonstrates improvements in the national HIV response but there is need to increase the number of persons on ART and achieving viral suppression.

Factors associated with discussing HIV pre-exposure prophylaxis (PrEP) among Jamaican medical providers

BACKGROUND

The Ministry of Health and Wellness of Jamaica has endorsed the use of pre-exposure prophylaxis (PrEP) as an HIV prevention strategy; however, PrEP was not included in the national HIV prevention program in 2021.

METHODS

A cross-sectional online study involving physicians in Jamaica was conducted in 2021 to describe PrEP awareness, beliefs, attitudes, and practices. The study also assessed individual and social factors associated with discussing PrEP with patients and willingness to prescribe PrEP.

FINDINGS

The mean age and standard deviation (SD) of the 69 physicians who completed the survey were 45.5 ± 13.6 years. Most of the participants (80%) reported that they were somewhat familiar with PrEP. PrEP attitude and perceived comfort in prescribing PrEP were moderate among participating physicians, with a mean and SD of 3.9 ± 0.8 and 3.6 ± 0.9 respectively. Six percent of physicians reported that they had prescribed PrEP and 17% had discussed PrEP with their patients in the past year. However, most (90%) reported that they were willing to prescribe PrEP after being informed about it. In the unadjusted model, identifying as Christian (compared to non-Christian) and reporting stronger homophobic beliefs were associated with reduced odds of discussing PrEP with patients. In the multivariable model, only homophobia remained statistically significant (OR, 0.24; 95% CI: 0.07-0.63).

CONCLUSION

The findings suggest that physicians in Jamacia may be willing to prescribe PrEP; however, homophobia is a barrier to discussions, underscoring the need for the Ministry of Health and Wellness to recognize the role that homophobia plays in the national HIV program to further reduce HIV incidence in Jamaica.

"It's Not Good to Be Sick and Have the Child": Perspectives on Pregnancy After HIV-Positive Diagnosis Among Women in Western Jamaica

Purpose

To identify factors associated with reproductive decision-making for women living with HIV in Western Jamaica, to assess their confidence in anti-retroviral therapy to reduce the chances of mother to child transmission of HIV, and to better understand the experience of stigmatization surrounding becoming pregnant after HIV diagnosis.

Participants and Methods

Two focus groups were conducted among women living with HIV in the four parishes of Western Jamaica in 2011. A trained moderator conducted the focus groups along with two student notetakers. Qualitative coding and content analysis were used to identify common themes and exemplary quotations characterizing those themes.

Results

Participants agree that adherence to antiretroviral therapy as prescribed by a physician facilitates better health and longevity; however, they were conflicted on the efficacy of the therapy to prevent mother to child transmission of the virus. Participants report that becoming pregnant after HIV diagnosis continues to be highly stigmatized. Among participants, fear of MTCT and concern that their children will be mistreated are the primary drivers of reproductive decision-making.

Conclusion

Despite advances in HIV treatment and assisted technologies to prevent MTCT, participants show skepticism that ARV medication is effective at preventing MTCT. Stigma and discriminatory behavior by community members and health-care professionals continue to shape reproductive decision-making for the women who participated in this study. More informed counseling that includes education on recent advancements in HIV treatment and its efficacy at preventing MTCT should be more widely available to pregnant women. To reduce stigma and discriminatory behavior, this education should extend to the larger community.