A handful of sex workers sit on discarded cardboard along a filthy sewer channel, sharing food and razors to shave their legs and faces as they prepare for the night's labor on the streets of Jamaica's capital. Gay sex and prostitution is illegal in Jamaica, and LGBT people who sell sex face arrest or worse. But this normally wary group is welcoming on a recent evening as a volunteer descends into the open channel with condoms, lubricant and health advice. In much of the world, giving out condoms and guidance to gay, bisexual and transgender sex workers is routine. But reaching out to men who have sex with men is practically revolutionary in parts of the English-speaking Caribbean, where homophobia and laws criminalizing gay sex have long driven people underground ? turning them into the toughest group to reach with HIV prevention programs and fueling a regional epidemic. Now, there's a growing momentum to turn the tide in Jamaica, Trinidad & Tobago, Guyana and eight other countries that criminalize sex between adults of the same gender. Even as funding grants get tighter, HIV prevention programs to reach men who have sex with men are scaling up and advocacy groups appear energized. A clear sign of changing times is Jamaica's Color Pink Group, a nonprofit founded in 2011 whose existence would have been almost unthinkable on the island a decade ago. On a recent night, founder James Burton, one of very few Jamaican homosexuals who feel comfortable disclosing their full name, wore a loud pink shirt as he spoke about HIV prevention to a group of young gays outside a Kingston shopping mall. But while societal acceptance of homosexuality is increasing, according to new polls commissioned by UNAIDS in eight Caribbean countries, the problem for gay men remains dire, even as the region has seen sharp declines in overall HIV infection for the population as a whole since 2000. Around the globe, men who have sex with men generally face elevated levels of HIV infection compared to heterosexual men. But experts say Caribbean nations with high levels of stigma have disproportionately high rates. Overall, the Caribbean has the highest rate of HIV outside sub-Saharan Africa, though both the overall and per capita numbers are much lower. Regional infection rates are highest for men who have sex with men in countries with longstanding laws that criminalize gay sex.
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