Men who have sex with men: the Caribbean reality
For over six months more than 3,500 Caribbean men who have sex with men (MSM) confided about their sex lives. They did so while seated at their computers. From Suriname to St Lucia, the US Virgin Island to Haiti, Cuba to Belize, 33 countries and territories were represented.
UNAIDS Caribbean Regional Support Team Director, Dr Ernest Massiah, presented preliminary findings of this study at the Global Forum on MSM and HIV (MSMGF) Pre-Conference meeting at the FHI 360 Headquarters Building in Washington DC.
Massiah explained that the Caribbean Men's Internet Survey (CARIMIS) received part-funding from the United States Agency for International Development (USAID). Technical support came from the London School of Hygiene and Tropical Medicine. The study set out to do something no traditional face-to-face survey could. It aimed to include the men that researchers wouldn't typically reach. These include the types who never go to gay parties and aren't among "community" networks.
The men who responded to CARIMIS embody the diversity of the region. Every single religion was counted—from Baptist to Baha'i, Catholic to Church of God. So too was every race.
Typical MSM surveys haven't attracted much participation from highly educated men. This one did, with more than three-quarters of the sample having had some post-secondary education.
For the first time in the Caribbean, the possibility of using the internet to reach so varied a population was tested. The premise? The internet provides opportunities for social and sexual networking.
Only 25 per cent of respondents had ever had contact with a lesbian, gay, bisexual and transgender (LGBT) community organisation. A mere 28 per cent had gone to a gay-friendly social space like a club or café. But 85 per cent connected with other MSM online.
One of the lessons CARIMIS will ultimately teach is whether the Caribbean could viably conduct behavioural studies on the internet with other hard-to-reach groups such as sex workers.
The wide-ranging questionnaire sought to determine men's HIV risk as well as their access to prevention, testing and treatment services. It started by seeking insight into the complex issues of identity and openness in Caribbean societies. The survey asked men who they're sexually attracted to with options reflecting the full spectrum of human sexuality, including degrees of attraction to both men and women.
Significantly, just under a quarter of the sample also have sex with women. What do they call themselves? Gay? Bi? Homosexual? 15 per cent of respondents didn't think of their sexuality in any of these terms.
The survey tried to find out how many Caribbean MSM are living their lives in relative secrecy, and what impact this might have on their happiness and access to healthcare services. Overall there was limited disclosure. Just over half of all respondents indicated that either few people or nobody knows that they are attracted to men.
Participants were asked whether they are happy with their sex lives. If not, why not? Concerns ranged from interpersonal relationships to health. One key finding was that being more open often increased men's vulnerability to verbal and physical abuse.
The range of questions on HIV and sexually transmitted infections (STIs) were about access to information, awareness of status, experience of confidentiality and adherence to treatment.
The frequency and nature of sexual contact, condom-use and sexual decision-making were also investigated.
Thousands of Caribbean men made the investment of time and honesty to contribute to a better understanding of their lives.
Final results will first be shared with the community at country and regional level before generating key messages for the full spectrum of stakeholders.