151
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Oldenburg CE, Perez-Brumer AG, Reisner SL, Mayer KH, Mimiaga MJ, Hatzenbuehler ML, Bärnighausen T. Human rights protections and HIV prevalence among MSM who sell sex: Cross-country comparisons from a systematic review and meta-analysis. Glob Public Health 2016; 13:414-425. [PMID: 26979302 DOI: 10.1080/17441692.2016.1149598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Laws and policies can affect the HIV risk of key populations through a number of direct and indirect pathways. We investigated the association between HIV prevalence among men who engage in transactional sex and language in the penal code protecting sexual minorities, including men who have sex with men (MSM), and sex workers. HIV prevalence among men who engage in transactional sex was assessed through meta-analysis of published literature and country surveillance reports. Meta-regression was used to determine the association between HIV prevalence and protective laws for sexual minorities and sex workers. Sixty-six reports representing 28 countries and 31,924 individuals were included in the meta-analysis. Controlling for multiple study- and country-level variables, legal protection for sexual minorities was associated with a 10.9% (95% CI: 3.8-18.0%) and sex workers associated with a 7.0% (95% CI: 1.3-12.8%) decrease in country-level HIV prevalence among men who engage in transactional sex. Laws that seek to actively protect sex workers and MSM may be necessary to decrease HIV risk for this key population.
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Affiliation(s)
- Catherine E Oldenburg
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Amaya G Perez-Brumer
- b Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA
| | - Sari L Reisner
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,c The Fenway Institute, Fenway Community Health , Boston , MA , USA
| | - Kenneth H Mayer
- c The Fenway Institute, Fenway Community Health , Boston , MA , USA.,d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,e Department of Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA
| | - Matthew J Mimiaga
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,e Department of Medicine , Beth Israel Deaconess Medical Center , Boston , MA , USA.,f Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA
| | - Mark L Hatzenbuehler
- b Department of Sociomedical Sciences , Columbia Mailman School of Public Health , New York , NY , USA
| | - Till Bärnighausen
- d Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA.,g Wellcome Trust Africa Centre for Health and Population Studies , Mtubatuba , South Africa
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152
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Santos GM, Makofane K, Arreola S, Do T, Ayala G. Reductions in access to HIV prevention and care services are associated with arrest and convictions in a global survey of men who have sex with men. Sex Transm Infect 2016; 93:62-64. [PMID: 26944344 DOI: 10.1136/sextrans-2015-052386] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/10/2016] [Accepted: 02/14/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Men who have sex with men (MSM) are disproportionately impacted by HIV. Criminalisation of homosexuality may impede access to HIV services. We evaluated the effect of the enforcement of laws criminalising homosexuality on access to services. METHODS Using data from a 2012 global online survey that was published in a prior paper, we conducted a secondary analysis evaluating differences in perceived accessibility to health services (ie, 'how accessible are ____' services) between MSM who responded 'yes'/'no' to: 'have you ever been arrested or convicted for being gay/MSM?' RESULTS Of the 4020 participants who completed the study and were included in the analysis, 8% reported ever being arrested or convicted under laws relevant to being MSM. Arrests and convictions were most common in sub-Saharan Africa (23.6% (58/246)), Eastern Europe/Central Asia (18.1% (123/680)), the Caribbean (15% (15/100)), Middle East/North Africa (13.2% (10/76)) and Latin America (9.7% (58/599)). Those arrested or convicted had significantly lower access to sexually transmitted infection treatment (adjusted OR (aOR)=0.81; 95% CI 0.67 to 0.97), condoms (aOR=0.77; 95% CI 0.61 to 0.99) and medical care (aOR=0.70; 95% CI 0.54 to 0.90), compared with other MSM, while accounting for clustering by country and adjusting for age, HIV status, education and country-level income. CONCLUSIONS Arrests and convictions under laws relevant to being MSM have a strong negative association with access to HIV prevention and care services. Creating an enabling legal and policy environment, and increasing efforts to mitigate antihomosexuality stigma to ensure equitable access to HIV services are needed, along with decriminalisation of homosexuality, to effectively address the public health needs of this population.
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Affiliation(s)
- Glenn-Milo Santos
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
| | - Keletso Makofane
- The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA
| | - Sonya Arreola
- The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA
| | - Tri Do
- Department of Community Health Systems, University of California, San Francisco, San Francisco, California, USA
| | - George Ayala
- The Global Forum on MSM and HIV (MSMGF), Oakland, California, USA
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153
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Grover E, Grosso A, Ketende S, Kennedy C, Fonner V, Adams D, Sithole B, Mnisi Z, Maziya SL, Baral S. Social cohesion, social participation and HIV testing among men who have sex with men in Swaziland. AIDS Care 2016; 28:795-804. [PMID: 26824888 DOI: 10.1080/09540121.2015.1131971] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Social cohesion and social participation are social factors that may help reduce HIV risks and optimize health-seeking behaviors. We examined the association between these factors and HIV testing in the last 12 months among men who have sex with men (MSM) in Swaziland using a cross-sectional survey conducted with 326 men, 18 years of age or older reporting having sex with another man in the last 12 months. Social capital analyses included measures of social cohesion and social participation. The social cohesion measurement scale was created through exploratory factor analysis using polychoric correlations to determine unidimensionality and Cronbach's Alpha to assess internal consistency. The measurement scale was divided at the 25th and 75th percentiles using "high," "medium" and "low" levels of social cohesion for between-group comparisons. The social participation index included four questions regarding participation, resulting in a participation index ranging from 0 to 4. In the final multivariate logistic regression model, an increase in the level of social participation was found to be significantly associated with HIV testing in the last 12 months, adjusting for age, income, reporting a casual partner, family exclusion and rejection by other MSM due to sexual orientation (adjusted odds ratio [aOR]: 1.3, 95% confidence interval [CI] 1.1-1.7, p < .01). MSM with high social cohesion had almost twice the odds of HIV testing in the last 12 months (aOR: 1.8, 95% CI 1.1-3.3, p < .05) as MSM with medium social cohesion, though the overall social cohesion variable was not found to be significant using a Wald test in either the adjusted or unadjusted logistic regression models. These data suggest that building solidarity and trust within and between groups may be a strategy to improve uptake of HIV testing.
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Affiliation(s)
- Elise Grover
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ashley Grosso
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sosthenes Ketende
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Caitlin Kennedy
- b Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Virginia Fonner
- c Department of Psychiatry and Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Darrin Adams
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | | | - Zandile Mnisi
- e Swaziland National AIDS Program , Mbabane , Swaziland
| | | | - Stefan Baral
- a Key Populations Program, Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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154
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Stahlman S, Bechtold K, Sweitzer S, Mothopeng T, Taruberekera N, Nkonyana J, Baral S. Sexual identity stigma and social support among men who have sex with men in Lesotho: a qualitative analysis. REPRODUCTIVE HEALTH MATTERS 2015; 23:127-35. [PMID: 26719004 DOI: 10.1016/j.rhm.2015.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022] Open
Abstract
Men who have sex with men (MSM) face sexual identity stigma in many settings, which can increase risk for HIV by limiting access to care. This paper examines the roles of social support, sexual identity stigma, and sexual identity disclosure among MSM in Lesotho, a lower-middle income country within South Africa. Qualitative data were collected from 23 in-depth interview and six focus group participants and content analysis was performed to extract themes. Four primary themes emerged: 1) Verbal abuse from the broader community is a major challenge faced by MSM in Lesotho, 2) participants who were open about their sexual identity experienced greater stigma but were more self-sufficient and had higher self-confidence, 3) relationships between MSM tend to be conducted in secrecy, which can be associated with unhealthy relationships between male couples and higher risk sexual practices, and 4) MSM community organisations provide significant social and emotional support. Friends and family members from outside the MSM community also offer social support, but this support cannot be utilised by MSM until the risk of disclosing their sexual identity is reduced. Greater acceptance of same-sex practices would likely result in more open, healthy relationships and greater access to social support for MSM.
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Affiliation(s)
- Shauna Stahlman
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kali Bechtold
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie Sweitzer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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155
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Stahlman S, Johnston LG, Yah C, Ketende S, Maziya S, Trapence G, Jumbe V, Sithole B, Mothopeng T, Mnisi Z, Baral S. Respondent-driven sampling as a recruitment method for men who have sex with men in southern sub-Saharan Africa: a cross-sectional analysis by wave. Sex Transm Infect 2015; 92:292-8. [PMID: 26424712 DOI: 10.1136/sextrans-2015-052184] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/12/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Respondent-driven sampling (RDS) is a popular method for recruiting men who have sex with men (MSM). Our objective is to describe the ability of RDS to reach MSM for HIV testing in three southern African nations. METHODS Data collected via RDS among MSM in Lesotho (N=318), Swaziland (N=310) and Malawi (N=334) were analysed by wave in order to characterise differences in sample characteristics. Seeds were recruited from MSM-affiliated community-based organisations. Men were interviewed during a single study visit and tested for HIV. χ(2) tests for trend were used to examine differences in the proportions across wave category. RESULTS A maximum of 13-19 recruitment waves were achieved in each study site. The percentage of those who identified as gay/homosexual decreased as waves increased in Lesotho (49% to 27%, p<0.01). In Swaziland and Lesotho, knowledge that anal sex was the riskiest type of sex for HIV transmission decreased across waves (39% to 23%, p<0.05, and 37% to 19%, p<0.05). The percentage of participants who had ever received more than one HIV test decreased across waves in Malawi (31% to 12%, p<0.01). In Lesotho and Malawi, the prevalence of testing positive for HIV decreased across waves (48% to 15%, p<0.01 and 23% to 11%, p<0.05). Among those living with HIV, the proportion of those unaware of their status increased across waves in all study sites although this finding was not statistically significant. CONCLUSIONS RDS that extends deeper into recruitment waves may be a promising method of reaching MSM with varying levels of HIV prevention needs.
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Affiliation(s)
- Shauna Stahlman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA
| | - Lisa G Johnston
- Department of Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Clarence Yah
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA Department of Biochemistry and Microbiology, Nelson Mandela Metropolitan University, South Africa
| | - Sosthenes Ketende
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA
| | | | - Gift Trapence
- Center for the Development of People, Blantyre, Malawi
| | - Vincent Jumbe
- Malawi College of Medicine, Blantyre, Malawi Centre for Global Health, Trinity College, Dublin, Ireland
| | | | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Center for Public Health and Human Rights, Baltimore, Maryland, USA
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156
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Seale A. Nigeria, MSM, and the law: from evidence to strategy. Lancet HIV 2015; 2:e267-8. [PMID: 26423250 DOI: 10.1016/s2352-3018(15)00107-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Andy Seale
- Rue de Lausanne 56, Geneva CH-1202, Switzerland.
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