Micah Fink, for the Pulitzer Center
Numbers, statistics and dates are notoriously difficult elements in any television script.
Most people find it hard to catch numbers on the fly. And when itcomes to complex statistics, well, let's just say that hearing them asa spoken word makes them even harder to grasp than usual.
So what does it mean when we report that a recent Jamaicangovernment study found that nearly one-third of gay men in Jamaica isHIV positive? Is this a high number or a low one? Is just one isolatedstudy really significant? And how does Jamaica's infection rate in thegay community compare with levels of infection in other countries?
While these questions are too complicated for a six-minutetelevision broadcast, they are more easily addressed in print. So hereare seven facts and one extrapolation to help place these figures intocontext.
Fact # 1: When we say that nearly 32 percent ofJamaica's gay community is infected with HIV, we are referring to astudy conducted in 2007-2008 by the Jamaican National HIV Control Program.This study was the very first controlled study of HIV rates inJamaica's gay community and found a 31.8 percent infection rate amongthe 201 gay men tested. More than half of the gay men tested werebetween 20 and 29, and nearly 30 percent of the group reported notusing a condom when they had sex during the past month. Eighty percentof the men studied reported having two or more male sexual partnersduring the past year. And interestingly, 33.8 percent of the totalgroup also reported having sex with at least two female partners in theprevious year.
Fact #2: "Controlled study," by the way, means thatthe researchers linked the anecdotal reports of each individual personstudied with their actual blood test. This technique is generallyconsidered a very reliable way to conduct HIV research.
Fact #3: HIV has been infecting people in Jamaicafor more than 25 years. The first case of AIDS was identified on theisland in 1982, but for several reasons the folks in charge of thenational response didn't decide to study how deeply the virus hadpenetrated the gay community until 2007-2008.
Fact #4: Only one other study of HIV infectionrates in Jamaica's gay community has ever been conducted. It was donemore than 10 years ago, in 1996, by Rossi Hassad, a graduate of theUniversity of the West Indies and public health researcher. Hassadreported that 31 percent of the gay men he tested were infected withHIV. This study was never officially confirmed or accepted by theJamaican Ministry of Health.
Fact #5: Based on the results of these two studies-- Hassad's in 1996 and the National Program's in 2008 - - it seemsapparent that HIV infection rates have likely been hovering between 31percent and 32 percent for more than a decade.
A fly-by-night extrapolation: I had to "run the numbers" for myselfto begin to understand the implications of these studies for Jamaicansociety. A conservative estimate used around the world suggests thatabout 10 percent of the total number of men in Jamaica may engage inhomosexual activities. Given a total population of 2.7 million, and afairly equitable breakdown of the sexes -- let's say 49 percent of thetotal population -- we come up with a total male population of roughly1.3 million individuals. Dividing by ten percent gives us an estimateof 130,000 gay men in Jamaica. Extrapolating from the Ministry ofHealth recent study means that 30 percent of this number are infectedwith HIV, and we arrive at the conclusion that some 39,000 gay Jamaicanmen may now be infected with HIV. Curiously, this number exceeds theMinistry of Health's current estimate for the total number of HIV casesin all of Jamaica, which is about 36,000 cases. This inconsistency isworth pondering.
Fact #6: The Ministry of Health's finding that 31.8percent of the gay Jamaican men are infected with the virus that causesAIDS is alarming. However, when it is discussed in reports tointernational agencies like UNAIDS, the numbers are played down as a"concentrated" epidemic. But what is a "concentrated" epidemic? Thisterm is how public health official now refer to infections within aspecific sector of society, as opposed to infection rates in all ofsociety, which is known as a "generalized" epidemic. Concentratedepidemics are now found in gay men, sex workers, handicappedcommunities, intravenous drug users and prisoners in Jamaica. However,calling these epidemics "concentrated" seems a bit misleading, sincemembers of these "communities" are seldom, if ever, really isolatedfrom rest of the general population. For example, as we saw above, morethan one-third of the gay men studied reported having two or morefemale partners in the previous year. Clearly, the gay men in Jamaica,not to mention sex workers and prisoners, have strong sexual links tothe "general population."
Fact #7: Jamaica is not the only country in theworld now reporting high HIV infection rates in local gay communities.Recent research on HIV rates in gay communities around the world --particularly in developing countries -- has found similarly high"concentrated" infection rates. Recent testing in gay populations inMumbai, India, found a 17 percent infection rate; in Bogotá, Columbia,20 percent of the gay men tested were infected. Two years ago, Mexicoreported a 15 percent infection rate and an older study in Trinidadtopped the list by reporting a 40 percent infection rate in the localgay community.
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