Shadeana Mascull and Njari Carr | Anticipate the roll-out of PrEP

HIV continues to be a major public-health issue globally. However, with increasing access to effective prevention, diagnosis, treatment and care options, it has been possible for HIV to be managed as a chronic health condition, enabling people living with HIV to lead long and healthy lives.

Our national response to HIV continues to be an important issue. According to UNAIDS, as of 2018 an estimate of 40,000 Jamaicans were living with HIV and an estimated prevalence rate of 1.6 per cent among the general population, according to the Ministry of Health and Wellness. These are very high rates for a small island.

Of this number, gay and bisexual men, as well as persons of trans experience, are disproportionately affected by the epidemic, with a prevalence rate of 29 per cent for MSM and 51 per cent for transwomen (the 876 Study, 2018).

Given the unfortunate legacy of discrimination which historically plagues the LGBT community, sexual fluidity and similar realities are often not discussed objectively among community members for fear of discrimination and possible violent responses.

When one’s sexual identity falls outside of the rigidly defined norms, high levels of discrimination and other negative attitudes can be experienced. The resulting fear of such experiences significantly contributes to cycles of problematic sexual behaviours within the LGBT community.

This, in addition to culturally inflexible ideas around gender identities and behaviours, puts everyone at risk when there are explicit and implicit expectations and messages that force us to conform to traditional beliefs. The pressure to prove one’s womanhood through childbearing and nurturing roles, coupled with the cultural demands for men to father children as proof of their virility and heterosexuality, help to drive the occurrence of multiple relationships.

Many times, a lack of honest discussion between partners, for fear of negative repercussions, limit safer sex conversations and positive health seeking behaviours such as routine HIV and STI testing. Therefore, with such a mixed fabric of sexual behaviours and practices, the transmission and contraction of STIs and STDs, including HIV, become a stark reality.

It is pleasing to note that in addition to the issuing of condoms and limited access to PrEP in cases of sexual assault or other possible exposure to the virus, the Government has decided to launch PrEP in 2020.

Pre-exposure prophylaxis (PrEP) is a drug taken to reduce the risk of contracting HIV. When taken effectively, for example, PrEP can effectively support a person who is HIV-negative to successfully establish and sustain a relationship with another person who is living with HIV without contracting the virus themselves.

With the approaching roll-out of PrEP by the Ministry of Health and Wellness as part of the national response to HIV, it is important that cultural barriers in navigating sexual identities and behaviours are addressed. Without a national approach around sensitising people about the interconnection between sexual identity, sexual behaviours and collective sexual health, the risk of transmission and contraction will remain high.

SUPPORT FOR HEALTHCARE SYSTEM

For high-risk populations, such as groups within the LGBT community, PrEP promises to be helpful in achieving national viral suppression. Naturally, there are associated health risks, and the most common side effects seen in studies of the drug include headache, nausea, vomiting, rash and loss of appetite. In some cases, issues related to kidney and liver functions have been reported.

Despite the possible side effects, we believe PrEP is a worthwhile undertaking by the Government to ensure that persons who are most at risk have additional prevention methods to reduce the transmission of HIV.

Our concern is largely around whether our healthcare facilities will be strengthened in their capacity to deal with the increased need for routine comprehensive testing for persons on PrEP. We are interested to see what additional support and strategy the Government will put in place to bolster the health care system after the roll-out.

As LGBT rights advocates, we support and anticipate the roll-out of PrEP in the nation’s efforts of achieving our 90-90-90 target – 90 per cent of all people living with HIV know their status; 90 per cent of people diagnosed with HIV receiving sustained antiretroviral therapy; and 90 per cent of all persons receiving antiretroviral therapy reaching viral suppression. We are looking forward to the positive impact this will have for the most vulnerable, and the resulting impact on the national response.

Shadeana Mascull and Njari Carr are members of the health team for Equality for All Foundation. Email feedback to columns@gleanerjm.com