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Pathways From Sexual Stigma to Inconsistent Condom Use and Condom Breakage and Slippage Among MSM in Jamaica

Logie, Carmen H., PhD*,†; Wang, Ying, MSW*; Marcus, Natania L., MA; Levermore, Kandasi, MPH§; Jones, Nicolette, MA§; Ellis, Tyrone, BA§; Marshall, Annecka, PhD; Newman, Peter A., PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 15, 2018 - Volume 78 - Issue 5 - p 513–521
doi: 10.1097/QAI.0000000000001712
Prevention Research

Background: HIV prevalence among men who have sex with men (MSM) in Jamaica, where same sex practices are criminalized, is among the Caribbean's highest. Sexual stigma, the devaluation, mistreatment, and reduced power afforded to sexual minorities, is a distal driver of HIV vulnerabilities. The mechanisms accounting for associations between sexual stigma and condom use outcomes are underexplored. We examined pathways from sexual stigma to condom use and condom breakage and/or slippage among MSM in Jamaica.

Methods: We conducted a cross-sectional survey with a chain-referral sample of MSM (n = 556) in Kingston, Montego Bay, and Ocho Rios. Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of sexual stigma on inconsistent condom use and condom breakage/slippage, and the indirect effects through depression, sexual abuse history, and condom use self-efficacy, adjusting for sociodemographic factors.

Results: One-fifth of participants (21%; 90/422) who had engaged in anal sex reported inconsistent condom use, and 38% (155/410) reported condom breakage/slippage during the previous 4 weeks. The relationship between sexual stigma and inconsistent condom use was mediated by the combination effect of sexual abuse history, condom use self-efficacy, and depression. The relationship between sexual stigma and condom breakage and slippage was mediated by the combination effect of condom use self-efficacy and sexual abuse history.

Conclusions: Sexual stigma is associated with negative condom use outcomes in Jamaican MSM, mediated by psychosocial factors. Multilevel social ecological approaches to the HIV prevention cascade can inform interventions at individual, interpersonal, community, and systemic levels.

*Factor-Iwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada;

Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada;

Department of Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada;

§Jamaica AIDS Support for Life, Kingston, Jamaica; and

Institute for Gender and Development Studies, University of the West Indies, Mona Campus, Kingston, Jamaica.

Correspondence to: Carmen H. Logie, PhD, Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Room 504, Toronto, Ontario, Canada M5S 1V4 (e-mail:

Supported by the Canadian Institutes of Health Research (CIHR) Operating Grant 0000303157; Fund: 495419, Competition 201209. C.H.L. efforts were in part supported by an Ontario Ministry of Research and Innovation Early Researcher Award. P.A.N. was supported in part by a Canada Research Chair in Health and Social Justice.

The authors have no conflicts of interest to disclose.

Received November 01, 2017

Accepted April 06, 2018

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