Perspective—Associations Between Police Harassment and HIV Vulnerabilities Among Men Who Have Sex with Men and Transgender Women in Jamaica
Carmen H. Logie, Ashley Lacombe-Duncan, Kathleen S. Kenny, Kandasi Levermore, Nicolette Jones, Annecka Marshall, and Peter A. Newman
Background
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. 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. 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.
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%. A recent study of transgender women in Jamaica reported an HIV prevalence of 25% among this group and reported that HIV infection was associated with violence. Qualitative studies have highlighted that violence targeting sexually and gender diverse people in Jamaica compromises their human rights and well-being.
The criminalization of same-sex practices in Jamaica dates back to 1864, during British colonial rule, with article 76 of the Offences Against the Person Act, which states that “buggery” (anal intercourse) is punishable by up to 10 years of imprisonment with possible hard labor. Under this provision, MSM and transgender women who are mislabeled as male, a concept known as misgendering, can also receive up to two years of imprisonment with possible hard labor if convicted of “being a male person who is party to the commission of any act of gross indecency with another male person.” Advocates suggest that arrest and prosecution are rare; instead, the law is used to justify other human rights violations, such as discrimination in employment, health, and housing, as well as violence. Human rights violations are not easily challenged given that sexual orientation and gender identity are not protected under Jamaica’s Charter of Fundamental Rights and Freedoms. A 2014 study by Human Rights Watch interviewed LGBT community members in Jamaica (n=71) and found that more than half had been victims of homophobic or transphobic violence. Over one-third had reported crimes to the police, who took formal statements in eight cases, resulting in only four arrests.
Some studies have begun to describe the impact of the criminalization of same-sex practices and homosexuality and, to a lesser extent, police harassment on HIV vulnerability among MSM and transgender women. A quantitative study conducted by Sonya Arreola et al. among MSM (n=3,340) from 115 countries found that lower levels of access to HIV prevention, testing, and treatment were associated with criminalization based on sexual orientation and gender identity and expression. In Nigeria, Sheree Schwartz et al. found that fear of seeking and avoidance of health care were higher for MSM after the country’s implementation of the Same Sex Marriage Prohibition Act. In Jamaica, current or previous incarceration due to being transgender was associated with substantially reduced odds of HIV testing among transgender women. Similarly, ever having been in jail was associated with increased odds of HIV infection among MSM in Jamaica. And in India, transgender women sex workers report experiencing such relentless police harassment that they are often forced to relocate and work in unfamiliar settings, decreasing their choice of clients and safety, which in turn increases their HIV vulnerability.
Utilizing Jamaica as a case study, this essay examines factors associated with police harassment targeting MSM and transgender women. We aim to demonstrate how police harassment in contexts where consensual same-sex sexual relations are criminalized shapes HIV vulnerabilities and operates as a social driver of HIV for MSM and transgender women. Read more via HHR