Layered Stigma Among Health Facility & Social Services staff Toward Most-at-Risk Populations in Jamaica

Published: April 1, 2012

Contents

Acknowledgments …………………………………………………………………………………………………………… iv
Acronyms ………………………………………………………………………………………………………………………. v
Executive Summary …………………………………………………………………………………………………………. 1
Components One and Two: Health Facility and Social Services Workers ………………………… 2
Component Three: Sex Workers Reports of S&D …………………………………………………………. 4
Conclusions and Recommendations ……………………………………………………………………………. 5
Background ……………………………………………………………………………………………………………………. 7
Introduction ……………………………………………………………………………………………………………………. 8
Methods ………………………………………………………………………………………………………………………. 10
Study Locations ……………………………………………………………………………………………………… 10
Instruments …………………………………………………………………………………………………………….. 10
Sampling ………………………………………………………………………………………………………………. 11
Data Collection Methods …………………………………………………………………………………………. 13
Data Entry and Analysis ………………………………………………………………………………………….. 14
Ethics and Consent ………………………………………………………………………………………………….. 14
Study Limitations ……………………………………………………………………………………………………. 14
Findings ………………………………………………………………………………………………………………………. 17
Components One and Two: Health Facility and Social Services Workers ………………………….. 17
Participant Demographics ………………………………………………………………………………………… 17
Organization Types …………………………………………………………………………………………………. 18
Participant’s Organizational Role ……………………………………………………………………………… 18
Training Exposure …………………………………………………………………………………………………… 19
S&D: Fear/Avoidance of Casual Contact with PLHIV, MSM, and SW …………………………. 21
Shame, Blame, Judgment …………………………………………………………………………………………. 27
Enacted Stigma ………………………………………………………………………………………………………. 30
Other S&D Measures ………………………………………………………………………………………………. 32
Vignette Findings ……………………………………………………………………………………………………. 32
Component Three: Sex Workers …………………………………………………………………………………… 38
Demographics ………………………………………………………………………………………………………… 38
Stigma and Discrimination……………………………………………………………………………………….. 39
Disclosure ……………………………………………………………………………………………………………… 40
Experience with Health Services within the Last Six Months ……………………………………….. 40
Experiences of SW in Ever Seeking Care …………………………………………………………………… 41
Use of HIV–Prevention Services and Medical Care …………………………………………………….. 43
Discussion ……………………………………………………………………………………………………………………. 46
Components One and Two: Health Facilities and Social Services Organizations …………….. 46
Component Three: Sex Workers ……………………………………………………………………………….. 48
Conclusions and Recommendations …………………………………………………………………………………. 49
Conclusions ……………………………………………………………………………………………………………. 49
Recommendations …………………………………………………………………………………………………… 51
References ……………………………………………………………………………………………………………………. 53
Annex 1: Health Facility Survey ………………………………………………………………………………………. 56
Annex 2: Social Services Survey ……………………………………………………………………………………… 69
Annex 3: Sex Worker Survey ………………………………………………………………………………………….. 82

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