Althea Bailey

Cervical cancer-related stigma is common but understudied in the Caribbean. This study aims to describe the age difference of cervical cancer stigma and to evaluate the influence on the prevention practices among the Caribbean non-patient population in Jamaica, Grenada, Trinidad and Tobago. A cross-sectional study involving 1,209 participants was conducted using a culturally trans-created Cancer Stigma Scale for the Caribbean context and supplemented with questions on cervical cancer and HPV/HPV vaccine knowledge and beliefs. Descriptive analyses and Chi-square tests were conducted. Chi-squared tests showed age is significantly related to participants’ response to stigma items such as “community members believe cervical cancer is viewed as shameful” (p = .0001); “women with cervical cancer are treated with less respect than usual by others” (p<.0001), “women with cervical cancer are rejected by family members” (p = .0007), “women with cervical cancer are rejected by intimate partners” (p<.0001), and “intimate partners blame women for having cervical cancer” (p = .0032). Additionally, age has significant associations with endorsements of negative views of cervical cancer from the community (p<.0001) and family (p<.0001) as key barriers to cervical cancer care (item: “discourage women from seeking and obtaining screening and treatment”). Notably, younger respondents (18-25 years) are more sensitized to the unfair stigma and hold more stigma. Among Caribbeans, age influences cervical cancer stigma. Younger persons acknowledged greater stigma within families and communities. This study can guide age-informed interventions and programs to reduce stigma and improve cervical cancer screening and care seeking to reduce cervical cancer burden and disparities.

Objectives To explore and compare anxiety relating to the threat of Covid-19 in pregnancy by women who conceived through assisted reproductive technology (ART) and spontaneously. We also examined the psychological coping strategies used and lived experience for both groups. Methods A total of 21 women who conceived through ART at a private university based IVF and a matched sample of women who conceived spontaneously were enrolled from July 2020 to February 2021. This was a mixed methods study. Covid-19-specific anxiety was measured using the coronavirus anxiety scale (CAS) as well as a validating qualitative data model with the use of open-ended questions to expand on quantitative findings. Results In both groups of women the level of anxiety detected by the CAS was low and mixed coping strategies (emotion-focused and problem-solving) were utilized. The ART group expressed more positive feelings towards pregnancy during the Covid-19 pandemic. Conclusion The vulnerable ART group is no more at risk for negative emotional well-being during the Covid-19 pandemic. Additionally, healthcare providers ought to be knowledgeable of various Covid-19 coping strategies that may provide emotionally protective measures for all women of reproductive age. This is of particular importance as effective coping may ultimately prevent disruptions that could compromise prenatal care during the covid-19 pandemic.

Objectives: This study sought to identify coronavirus disease 2019 (COVID-19) risk communication materials distributed in Jamaica to mitigate the effects of the disease outbreak. It also sought to explore the effects of health risk communication on vulnerable groups in the context of the pandemic. Methods: A qualitative study was conducted, including a content analysis of health risk communications and in-depth interviews with 35 purposively selected elderly, physically disabled, persons with mental health disorders, representatives of government agencies, advocacy and service groups, and caregivers of the vulnerable. Axial coding was applied to data from the interviews, and all data were analyzed using the constant comparison technique. Results: Twelve of the 141 COVID-19 risk communication messages directly targeted the vulnerable. All participants were aware of the relevant risk communication and largely complied. Barriers to messaging awareness and compliance included inappropriate message medium for the deaf and blind, rural location, lack of Internet service or digital devices, limited technology skills, and limited connection to agencies that serve the vulnerable. Conclusion: The vulnerable are at increased risk in times of crisis. Accessibility of targeted information was inadequate for universal access to health information and support for vulnerable persons regardless of location and vulnerability.

Purpose To identify staff and participants perspectives of best practices that facilitate achieving enrollment and retention targets in biomedical cohort studies in Caribbean populations. Methods Eight focus group discussions (FGDs) were held with research stakeholders including research (i) nurses/study supervisors, (ii) field staff/data collectors, and (iii) rural and urban participants of the Third Jamaica Health and Lifestyle Survey (a national NCD risk factor survey with biospecimen collection) to capture qualitative data on experiences with recruitment, training, retention challenges and potential solutions or strategies for strengthening future efforts. Results Our findings indicate that trained, experienced study staff with good interpersonal communication skills enhanced the proficiency of field operations and attracted study participants. Targeted community and stakeholder engagement alongside strong support from the coordinating center increased the reach and efficiency of the data collectors. Timely participant feedback, gender-appropriate approaches, and socioeconomic balance enhanced equitable enrollment and retention of participants of cohort studies particularly the hard to reach groups. Conclusion Well-functioning research teams using traditional and social media promotion, applying gender-appropriate and personalized approaches together with strategies for reaching the less accessible socioeconomic groups, are effective for recruiting and retaining members of a Caribbean cohort. These strategies may also enhance the recruitment of other Black populations in the Diaspora including the US and Caribbean into biomedical studies including cancer research.

Small island Caribbean countries such as Jamaica are now facing an epidemic of obesity and decreased physical activity (PA) levels. Public parks have been shown to be important resources for PA that also provide psychological and social benefits associated with increased PA. There are no studies that document PA in parks in the Caribbean. This study utilized a mixed method approach by using the System for Observing Play and Recreation in Communities (SOPARC) to obtain baseline data on park usage patterns in Emancipation Park, a large urban public park in Jamaica. In addition, in-depth interviews were conducted to gain additional insights on the park’s use for PA. The park was used mostly by females, in the evenings and by persons 18–64 years old. Females had significantly lower mean energy expenditure (EE) than males (0.078 versus 0.080 kcal/kg/min, p < 0.05). In-depth interviews revealed that safety, a central location within a business district, aesthetic appeal, a walking track and individual health benefits were key reasons for persons engaging in PA at the park. This is the first study to describe the usage of a public park for PA in Jamaica. The study elicited aspects of park use for PA in a major urban park in Jamaica from different vantage points by using direct systematic observation augmented with a qualitative approach. It revealed important differential park use for PA by sex, age group and EE levels, and provided insights into factors that motivate and hinder park usage for PA. This can be used by policymakers in Jamaica to inform PA interventions to reduce obesity, provide baseline data for comparisons with other parks in developing countries and to advocate for well-designed public parks.

This paper explores barriers to consistent condom use among female sex workers in Jamaica in a qualitative study using grounded theory. Multiple perspectives were sought through 44 in-depth interviews conducted with female sex workers, clients, the partners of sex workers and facilitators of sex work. Poverty and lack of education or skills, severely limited support systems as well as childhood abuse served to push the majority of participants into sex work and created vulnerability to HIV and other STIs. Despite these constraints, women found ways to exercise agency, ensure condom use, adopt protective measures and gain economic advantage in various aspects of the Jamaican sex trade. Perceived relationship intimacy between sex workers and their clients and/or their main partners emerged as the main factor contributing to reduced risk perception and inconsistent condom use. Relationship intimacy, with associated trust and affirmation of self, is the most important factor influencing sexual decision-making with respect to lapse in condom use among female sex workers in Jamaica. Study findings provide important insights that can enhance individual psychosocial, interpersonal and community-based interventions as well as inform environmental, structural and policy interventions to reduce risk and vulnerability among female sex workers. ResumeCet article explore les obstacles a l'usage regulier du preservatif chez les travailleuses du sexe a la Jamaique, selon une etude qualitative qui s'est basee sur la theorie ancree. Des points de vue multiples ont ete recherches a travers 44 entretiens en profondeur realises avec des travailleuses du sexe, des clients, les partenaires des travailleuses du sexe et des facilitateurs du travail du sexe. De meme que les abus sexuels dans l'enfance, la pauvrete et l'absence d'education ou de competences limitaient gravement les systemes de soutien, servaient a pousser la majorite des participantes vers le travail du sexe, et creaient une vulnerabilite au VIH et aux autres IST. En depit de ces contraintes, les femmes trouvaient des moyens d'exercer leur faculte d'action, de veiller a ce que le preservatif soit utilise, d'adopter des mesures preventives et de beneficier d'avantages economiques dans divers aspects du commerce du sexe a la Jamaique. Les perceptions sur l'intimite au sein des relations entre les travailleuses du sexe et leurs clients et/ou leurs partenaires principaux, se sont revelees comme etant le facteur majeur contribuant a la perception d'une reduction des risques et a l'usage irregulier du preservatif. L'intimite au sein des relations, avec la confiance et l'affirmation de soi qui lui sont associees, a ete le plus important facteur d'influence sur la prise de decisions sur le comportement sexuel, relativement a la diminution de l'usage du preservatif chez les travailleuses du sexe a la Jamaique. L'etude apporte un eclairage qui peut permettre d'ameliorer les interventions interpersonnelles et communautaires, de meme que d'orienter les interventions aux plans environnemental, structurel et politique qui se donnent pour objectif la diminution des risques et de la vulnerabilite parmi les travailleuses du sexe. ResumenA partir de un estudio cualitativo basado en la teoria fundamentada, el presente articulo examina los obstaculos existentes para el uso sistematico del condon entre las sexoservidoras de Jamaica. A traves de 44 entrevistas en profundidad efectuadas con sexoservidoras, clientes, parejas de las sexoservidoras y facilitadores del trabajo sexual, se pretendio obtener multiples perspectivas. Se constato que factores como la pobreza, la falta de escolaridad o de habilidades, los muy limitados sistemas de apoyo y el maltrato infantil llevaron a la mayoria de las entrevistadas hacia el trabajo sexual, lo que elevo su vulnerabilidad al vih y a otras its. A pesar de ello, las mujeres encontraron la manera de ejercer su capacidad de agencia, asegurar el uso del condon, adoptar medidas de proteccion y lograr una ventaja economica en los distintos aspectos del trabajo sexual en Jamaica. Asimismo, el estudio evidencio que el principal factor que contribuye a la reducida sensacion de riesgo y al uso irregular del condon es la percepcion de cierta intimidad relacional entre las sexoservidoras y sus clientes y/o sus parejas principales. Asi, la intimidad relacional, y la consiguiente confianza y autoafirmacion que conlleva, opero como el factor mas importante en el momento de la toma de decisiones que condujo a irregularidades en el uso del condon entre estas sexoservidoras. El estudio provee importantes hallazgos que pueden reforzar las intervenciones individuales, psicosociales, interpersonales y comunitarias, ademas de alimentar las intervenciones ambientales, estructurales y de politicas publicas orientadas a reducir el riesgo y la vulnerabilidad de las sexoservidoras.

The Jamaican government has provided targeted HIV and sexually transmitted infection prevention, treatment, and other services for female sex workers (FSW) since 1989. HIV prevalence among FSW declined from 20 to 12 % between 1989 and 1994, then to 9 % in 2005, 5 % in 2008, and 4.1 % in 2011. This article distills the literature and two decades of experience working with FSW in Jamaica. Drawing on the constant comparative method, we put forward an innovative conceptual framework for explaining sexual decision-making and risk behaviors within both transactional and relational sexual situations. This framework helps fill the gaps in existing models that focus on individual behaviors. The model identifies interactions between environmental and structural elements of sex work, and three individual-level factors: risk perception, perceived relationship intimacy, and perceived control, as the four primary mediating factors influencing sexual decision-making among FSW. We propose that other factors such as violence, socioeconomic vulnerability, and policy/legal frameworks influence sexual decision-making through these primary mediating factors. This conceptual model may offer a useful framework for planning and evaluating prevention interventions among sex workers. However, it remains to be tested in order to establish its value.