KINGSTON, Jamaica (AP) — 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.
"It's hard living like this, but we're trying our best to stay safe and healthy. Nobody wants to get HIV," says one of the gay men, a shirtless 21-year-old who gives his name only as Kris.
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.
"We are in an entirely new era," said Ernest Massiah, the Trinidad-based Caribbean director for the United Nations program on HIV and AIDS.
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.
"This is what was really lacking before: visibility and one-on-one connections," said Burton, whose group also provides vocational training and distributes condoms and lubricant.
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. One study published in the medical journal Lancet in 2012 found that the HIV prevalence for them in the Caribbean is one of the highest documented rates in the world.
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.
In Jamaica, roughly 1.7 percent of the adult population has HIV, according to UNAIDS. But roughly 33 percent of men who have sex with men are believed to be infected on the island. It's the highest rate for that population in the Americas and one of the highest anywhere.
In a bid to tackle discrimination against gay men in the health care system, the rights group Jamaica Forum of Lesbians, All-Sexuals and Gays has partnered with a government HIV program to sensitize hospital and clinic staff to homosexuals' human rights. It can be as simple as training health workers not to narrow their eyes or cast judgment on any patient seeking a rectal exam.
Burton's organization and other groups also regularly visit the sewer where emboldened young people like Kris are helping bring Jamaica's gay and transgender community out of the shadows. Most gay men in Jamaica stick to a "don't ask, don't tell" policy of keeping their sexual orientation hidden to avoid scrutiny or protect loved ones. But Kris' crowd rowdily congregates on the streets.
There's increasing acknowledgment among political leaders that discouraging discrimination against people with HIV will buoy efforts to fight the virus. At a regional conference on HIV held in Kingston last month, Jamaican Health Minister Fenton Ferguson called on regional politicians to "put aside our personal beliefs, discomfort and prejudices" and "initiate frank dialogue on stigma."
But with homosexual sex still outlawed, "it's very difficult to change the mentality in a meaningful way," said Dr. Geoffrey Barrow, clinical coordinator at the HIV/AIDS center at the University of the West Indies.