A community mobilisation intervention to improve engagement in HIV testing, linkage to care, and retention in care in South Africa: a cluster-randomised controlled trial

A Scoping Review of Stigma Related to Prostate Cancer in Black Men

BACKGROUND

Prostate cancer (CaP) disproportionately affects 1-in-4 Black men and is a stigmatised disease within their communities. Yet, Black men are underrepresented in CaP research concerning stigma, which necessitates a scoping review to map available evidence on this topic to inform future research.

AIMS

To map published literature on stigma related to CaP in Black men to understand their experiences and/or perceptions and identify directions for future research.

METHODS

A scoping review was conducted using the five-step framework by Arksey and O'Malley. Studies published in English addressing stigma related to CaP from the perspectives of Black men and/or their families were included. We searched six databases including Medline, Embase, PsycInfo, CINAHL, Web of Science Core Collection and Google Scholar, from inception to April 2023. Citation searches were also conducted. Two independent reviewers conducted screening and data extraction. Data was synthesised using descriptive content analysis.

RESULTS

Thirty-four eligible studies conducted in the USA, UK, Trinidad and Tobago, South Africa, Cameroon and Canada from 1995 to 2023 were included. A total of 1867 Black men with/without a CaP diagnosis and 145 adult partners were included. Review findings showed a complex intersection of self-stigma, public stigma and structural stigma impacted Black men's perceptions of their masculinity. While men's experiences/perceptions of stigma varied depending on their illness status, there were commonalities in their masculinity concerns (underpinned by stigma), which influenced their attitude towards digital rectal examination, post-treatment side effects and social interactions on CaP. These have implications for public health messaging on CaP within Black communities, as well as patient-provider interactions with the men.

CONCLUSIONS

This novel review highlights the need to pay attention to how CaP is presented to Black men and their communities using avenues and languages that are culturally acceptable and empower them to negotiate self-stigma, public stigma and structural stigma related to CaP. Directions for further research were also identified.

The use of monitoring data and community feedback mechanisms to increase HIV testing among men during a cluster-randomised community mobilisation trial in South Africa

This short communication describes the development and implementation of a programme monitoring and feedback process during a cluster-randomised community mobilisation intervention conducted in rural Bushbuckridge, Mpumalanga, South Africa. Intervention activities took place from August 2015 to July 2018 with the aim of addressing social barriers to HIV counselling and testing and engagement in HIV care, with a specific focus on reaching men. Multiple monitoring systems were put in place to allow for early and continuous corrective actions to be taken if activity goals, including target participation numbers in events or workshops, were not reached. Clinic data, intervention monitoring data, team meetings and community feedback mechanisms allowed for triangulation of data and creative responses to issues arising in implementation. Monitoring data must be collected and analysed carefully as they allow researchers to better understand how the intervention is being delivered and to respond to challenges and make changes in the programme and target approaches. An iterative process of sharing these data to generate community feedback on intervention approaches was critical to the success of our programme, along with engaging men in the intervention. Community mobilisation interventions to target the structural and social barriers impeding men's uptake of services are feasible in this setting, but must incorporate a continuous review of monitoring data and community collaboration to ensure that the target population is reached, and may need to also be supplemented by changes in the structure of care provision.