Associations between Police Harassment and HIV Vulnerabilities among Men Who Have Sex with Men and Transgender Women in Jamaica

The criminalization of same-sex practices constrains HIV prevention for gay, bisexual, and other men who have sex with men (MSM) and, in part due to the conflation of gender and sexuality, transgender women.1 Criminalization is a structural driver of HIV that indirectly influences HIV vulnerability through multiple pathways: decreased funding for HIV prevention, treatment, and care programs tailored for MSM and transgender women; increased fear of seeking health care; denial of services due to stigma; social and familial exclusion that may contribute to elevated rates of homelessness; employment and housing discrimination that elevate economic insecurity and increase survival sex work; and a lack of human rights protection that increases exposure to violence from community members and the police.2 Criminalization may result in enacted stigma, such as overt forms of social exclusion and violence, and perceived stigma, whereby people experience fear and concerns of rejection and negative treatment by others because of actual or perceived sexual or gender minority identity.3 There is scant evidence directly linking human rights violations of MSM and transgender women to HIV vulnerabilities in middle-income contexts where same-sex practices are criminalized. MSM in Jamaica have the highest HIV rates in the Caribbean, estimated between 14% and 31%.4 A recent study of transgender women in Jamaica reported an HIV prevalence of 25% among this group and reported that HIV infection