Disclosure, stigma, and HIV care among sex workers and men who have sex with men living with HIV in Jamaica.

Abstract

BackgroundHIV-related stigma remains a barrier to HIV care cascade engagement among key populations globally. In Jamaica, men who have sex with men (MSM) and female sex workers (FSW) living with HIV experience intersecting stigma that complicates disclosure decision-making and HIV care engagement. Guided by the Disclosure Processes Model, this study examined how approach and avoidance-focused goals shaped disclosure-related outcome aims, affective responses, and coping strategies related to HIV care engagement among MSM and FSW living with HIV in Jamaica.MethodsThis community-based qualitative study was conducted with an AIDS Service organization across Kingston, St Ann, and Montego Bay, Jamaica (2020-2022). We conducted six focus groups with MSM and FSW living with HIV (n = 46), followed by comic-guided in-depth individual interviews (n = 31). We conducted codebook thematic analysis informed by the antecedent goals component of the Disclosure Processes Model. Analyses explored how approach and avoidance-focused goals shaped outcome aims, affect, and coping strategies related to HIV disclosure and care engagement.ResultsParticipants (n = 28 FSW, n = 49 MSM) described disclosure decision-making was shaped by competing aims to achieve positive outcomes and avoid stigma-related harms. Approach-focused goals related to disclosure focused on pursuing positive outcomes (preserving health; sustaining family responsibilities; building a meaningful future), positive affect (peace of mind; hopefulness), and coping (accessing social support; self-acceptance). Avoidance-focused disclosure related goals centered prevention of negative outcomes (confidentiality breaches; social rejection), negative affect (fear; worry; isolation), and avoidance coping (concealment; social withdrawal). Participants described healthcare settings, pharmacies, workplaces, and family environments as spaces of potential disclosure risk.ConclusionHIV disclosure decision-making among MSM and FSW participants was a complex process shaped by stigma, distress, and institutional mistrust, and also access to social support. Findings underscore the need for trauma-informed and stigma reducing HIV services that support safe disclosure and HIV care engagement with key populations in Jamaica.