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Haaland I, Metta E, Moen K. The use of PrEP among men who have sex with men and transgender women as Biomedical Prevention Work: A conceptual framework. Soc Sci Med 2023; 333:116147. [PMID: 37556992 DOI: 10.1016/j.socscimed.2023.116147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/06/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
Based on ethnographic fieldwork among men who have sex with men and transgender women in Tanzania, this article explores the various types of work that may go into enrolment into PrEP programming and using pre-exposure prophylaxis (PrEP). PrEP protects against HIV acquisition and is widely touted as an essential tool in 'ending AIDS by 2030'. While taking PrEP has often been portrayed as 'just taking a pill a day' in public health campaigns, a striking observation during fieldwork was that enrolling in PrEP programming and adhering to PrEP involved a wide range of tasks. Inspired by this fieldwork experience and the literature on sociology of work, more specifically illness work and patient work, we started to think of these tasks as work. This paper identifies the range of tasks that PrEP users in Dar es Salaam had to perform as part of their enrolment and usage of PrEP. We provide a description of these tasks, organised into three categories of work that we refer to as (a) readying work, (b) user work, and (c) social navigation work that jointly make up what we propose to call biomedical prevention work. We further suggest that this analytical framework can be applicable to other biomedical prevention methods in other contexts.
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Affiliation(s)
- Inga Haaland
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Emmy Metta
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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Isano S, Yohannes T, Igihozo G, Ndatinya GI, Wong R. A qualitative study to explore the healthcare-seeking experiences of men who have sex with men (MSM) and transgender women (TGW) in Rwanda. BMC Health Serv Res 2023; 23:291. [PMID: 36978054 PMCID: PMC10045920 DOI: 10.1186/s12913-023-09286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Globally, men who have sex with men (MSM) and transgender women (TGW) encounter many challenging experiences when accessing health services compared to the general population. Stigma, discrimination, and punitive laws against same-sex relationships in some sub-Saharan African countries have made MSM and TGW more prone to depression, suicidal ideation, anxiety disorders, substance abuse, non-communicable diseases, and HIV. None of the prior studies in Rwanda on MSM and TGW had explored their lived experience in accessing health services. Accordingly, this study aimed at exploring the healthcare-seeking experiences of MSM and TGW in Rwanda. METHODS This study utilized a qualitative research method employing a phenomenological design. Semi-structured in-depth interviews were conducted with 16 MSM and 12 TGW. Participants were recruited via purposive and snowball sampling approaches in five districts in Rwanda." RESULTS Data were analyzed using a thematic analysis approach. Three main themes emerged from the study: (1) The healthcare experiences of MSM and TGW were generally dissatisfactory, (2) MSM and TGW hesitated to seek care unless they were severely ill, (3) MSM and TGW's perspectives on how to improve their health-seeking behavior. CONCLUSION MSM and TGW in Rwanda continue to face negative experiences within the healthcare delivery settings. These experiences include mistreatment, refusal of care, stigma, and discrimination. Provision of services for MSM and TGW and On-the-job cultural competence training in the care of MSM and TGW patients is needed. Including the same training in the medical and health sciences curriculum is recommended. Furthermore, awareness and sensitization campaigns to improve the understanding of the existence of MSM and TGW and to foster acceptance of gender and sexual diversity in society are necessary.
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Affiliation(s)
- Sandra Isano
- Department of Community Health and Social Medicine, University of Global Health Equity, Kigali, Rwanda.
| | - Tsion Yohannes
- Center of Gender Equity, University of Global Health Equity, Kigali, Rwanda
| | - Gloria Igihozo
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
| | - Grace Iliza Ndatinya
- Department of Community Health and Social Medicine, University of Global Health Equity, Kigali, Rwanda
| | - Rex Wong
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
- School of Public Health, Yale University, Yale, USA
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Mgopa LR, Ross MW, Lukumay GG, Mushy SE, Mkony E, Massae AF, Mwakawanga DL, Leshabari S, Mohamed I, Trent M, Wadley J, Bonilla ZE, Rosser BRS. Perceptions of Sexual Healthcare Provision in Tanzania: a Key Informant Qualitative Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:849-859. [PMID: 36172532 PMCID: PMC9514134 DOI: 10.1007/s13178-021-00607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Sexual health care services must be standard and unbiased, guided by a structured health care system. There is a scarcity of data on how sexual health care is delivered in Tanzania. METHODS To address this gap, in July 2019 we interviewed eleven key informants: cultural and public health experts, and political, religious, and community leaders, selected from different organizations in Dar es Salaam, Tanzania. Participants were asked for their opinions about clinical practices of health care professionals when providing care to patients, with an emphasis on sexual health. RESULTS Participants' responses were classified into three subcategories: strengths, barriers, and gaps in sexual health care. Availability of services, service delivery to adults, and code of conduct were among the strengths observed in clinical care services. Barriers included the health care provider's attitudes, moral values, and inadequacy in health policies and treatment guidelines. Vulnerable populations including youth were frequently reported to face most challenges when seeking sexual health care services. In terms of gaps, informants emphasized gender equity in sexual health services provision within care settings. CONCLUSION AND IMPLICATION Data indicate that lack of training in sexual health and guidelines for dealing with sexual issues are a barrier to comprehensive health care. These findings can inform the main areas for curriculum developers to focus on, when developing an Afro-centric sexual health curriculum suitable for students in health care professional courses. Moreover, these findings can be useful when developing treatment guidelines and policies that are beneficial to the sexual health wellbeing of individuals.
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Affiliation(s)
- Lucy R. Mgopa
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Michael W. Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella Emmanuel Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkony
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Agnes F. Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dorkas L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohamed
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maria Trent
- Department of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA
| | - James Wadley
- Department of Counselling and Health Services, Lincoln University, Philadelphia, PA, USA
| | - Zobeida E. Bonilla
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - B. R. Simon Rosser
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Haase S, Müller A, Zweigenthal V. Sexual health behavior, health status, and knowledge among queer womxn and trans men in Kenya: An online cross-sectional study. PLoS One 2022; 17:e0268298. [PMID: 35714150 PMCID: PMC9205489 DOI: 10.1371/journal.pone.0268298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/23/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Little research has been conducted on the sexual health needs and risk behaviors of queer womxn and trans men, making it difficult to identify specific health needs and disparities. This is especially the case in the Global South, where their needs are poorly understood. This study presents findings on demographics, sources of information, sexual (risk) behaviors, and substance use in Kenyan queer womxn and trans men. Methods An online survey among 335 Kenyan queer womxn and trans men was used to collect data on sexual health, risk behavior, health information sources, and substance use. The participants needed to have had at least one self-identified female sexual partner. Results The sample presented young, highly-educated queer womxn and trans men. A high incidence of childhood sexual trauma found was found. Risk behaviors included sexual activities with partners of multiple genders, violence, and low use of barrier methods. One in three participants had been treated for an STD in the previous year. The incidences of smoking and drinking were high, and a quarter of participants indicated having taken drugs at least once a month or more. The internet was either the first or second most important source of sexual health information for 44.1% of the participants, followed by schools (30.9%). Discussion and conclusion Our findings indicate that queer womxn and trans men are at risk of negative sexual health outcomes due to a lack of appropriate information, risk behavior, substance use, and low uptake of sexual health services. Kenya’s Penal Code still criminalizes consensual same-sex activities and may play a role in perpetuating barriers that prohibit them from making healthier choices. Developing tailored programming and policies require local, national, and global stakeholders to engage with the inclusion of queer womxn and trans men’s sexual health needs within strategic planning and healthcare delivery.
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Affiliation(s)
- Stephanie Haase
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Alex Müller
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Virginia Zweigenthal
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Rosser BRS, Mkoka DA, Rohloff CT, Mgopa LR, Ross MW, Lukumay GG, Mohammed I, Massae AF, Mkonyi E, Mushy SE, Mwakawanga DL, Kohli N, Trent ME, Wadley J, Bonilla ZE. Tailoring a sexual health curriculum to the sexual health challenges seen by midwifery, nursing and medical providers and students in Tanzania. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35695444 PMCID: PMC9210149 DOI: 10.4102/phcfm.v14i1.3434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Tanzania is a country experiencing multiple sexual health challenges, but providers receive no formal training in sexual health. AIM This study aimed to assess (1) what sexual health challenges are commonly seen in clinics in Tanzania, (2) which are raised by patients, (3) which are not addressed and (4) which topics to prioritise for a sexual health curriculum. SETTING Healthcare settings in Tanzania. METHODS Participants were 60 experienced and 61 student doctors, nurses and midwives working in Dar es Salaam. The authors conducted 18 focus groups stratified by profession (midwifery, nursing or medicine) and experience (practitioners vs. students). RESULTS Providers identified six common sexual health concerns: (1) Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and sexually transmissible infection (STI) (especially syphilis and gonorrhoea), (2) sexual violence (including intimate partner violence and female genital mutilation), (3) early and unwanted pregnancy (including early sexual debut and complications from abortion), (4) sexual dysfunctions, (5) key population concerns (e.g. lesbian, gay, bisexual, transgender (LGBT); sex work) and (6) non-procreative sexual behaviour (including pornography and masturbation in males and oral and anal sex practices in heterosexual couples). Across professions, few differences were observed. Homosexuality, sex work, masturbation and pornography were identified as taboo topics rarely discussed. Most participants (81%) wanted one comprehensive sexual health curriculum delivered across disciplines. CONCLUSION A sexual health curriculum for health students in Tanzania needs to address the most common sexual health concerns of patients. In addition to teaching sexual science and clinical care, skills training in how to address taboo topics is recommended. Students endorsed almost all sexual health topics, which suggests that a comprehensive curriculum is appropriate.
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Affiliation(s)
- B R Simon Rosser
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, United States of America.
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Mwijage Ishungisa A, Meyrowitsch DW, Mmbaga EJ, Leshabari MT, Moen K. Not a Problem at All or Excluded by Oneself, Doctors and the Law? Healthcare Workers' Perspectives on Access to HIV-Related Healthcare among Same-Sex Attracted Men in Tanzania. J Int Assoc Provid AIDS Care 2022; 21:23259582221121448. [PMID: 35989640 PMCID: PMC9403446 DOI: 10.1177/23259582221121448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: An increasing body of literature focuses on access to
healthcare services for men who engage in sex with other men in Africa, but how
healthcare workers conceive of this topic of healthcare workers’ views on men's
care has not been much studied. Drawing on qualitative research, this article
explores healthcare providers’ perspectives on access to HIV-related healthcare
services among gender and sexuality diverse men in Tanzania.
Methods: A qualitative study was conducted among healthcare
workers in Dar es Salaam and Tanga, Tanzania in 2018/2019. Data collection
entailed qualitative interviewing, focus group discussions and participant
observation. A purposive sampling strategy was used to select study participants
who varied with respect to age, education level, work experience, and the type
and location of the facilities they worked in. A total of 88 participants took
part in the study. Results: This paper describes four different
discourses that were identified among healthcare workers with respect to their
perception of access to healthcare services for men who have sex with men. One
held that access to healthcare was not a major problem, another that some
same-sex attracted men did not utilize healthcare services although they were
available to them, a third that some healthcare workers prevented these men from
gaining access to healthcare and a fourth that healthcare for gender and sexual
minority persons was made difficult by structural barriers.
Conclusion: Although these are four rather different takes on
the prevailing circumstances with respect to healthcare access for same-sex
attracted men (SSAM), we suggest that they may all be “true” in the sense that
they grasp and highlight different aspects of the same realities. More education
is needed to healthcare providers to enable them accept SSAM who seek healthcare
services and hence improve access to healthcare.
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Affiliation(s)
- Alexander Mwijage Ishungisa
- Department of Behavioural Sciences, 92976Department of Epidemiology and Biostatistics of the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, 53139University of Copenhagen, Kobenhavn, Denmark
| | - Elia John Mmbaga
- Department of Behavioural Sciences, 92976Department of Epidemiology and Biostatistics of the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,60504Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Melkizedeck Thomas Leshabari
- Department of Behavioural Sciences, 92976Department of Epidemiology and Biostatistics of the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kåre Moen
- 60504Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Shangani S, Genberg B, Harrison A, Pellowski J, Wachira J, Naanyu V, Operario D. Cultural adaptation and validation of a measure of prejudice against men who have sex with men among healthcare providers in western Kenya. Glob Public Health 2022; 17:150-164. [PMID: 33306434 PMCID: PMC8192581 DOI: 10.1080/17441692.2020.1860248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sexual prejudice toward men who have sex with men (MSM) is a pressing concern in sub-Saharan Africa (SSA). Given the high HIV infection risk among this population, sexual prejudice perpetuated by healthcare providers, affects access to and willingness of MSM to seek HIV care services. However, data on healthcare providers' attitudes towards MSM in SSA are limited, and there are no locally-adapted measures of sexual prejudice. We adapted a scale to measure sexual prejudice with a sample of 147 healthcare providers in western Kenya. Results from exploratory factor analysis revealed a single-factor structure. The scale demonstrated high internal consistency with Cronbach's α = 0.91. Healthcare providers who had prior interpersonal contact with MSM, had ever been trained on counselling MSM, and had higher knowledge about MSM health needs reported lower sexual prejudice scores, compared with peers who lacked these experiences (p < 0.001). In contrast, healthcare providers who had experienced secondary stigma (negative judgments from peers and community) for providing care to MSM reported higher scores of sexual prejudice scale (p < 0.001) compared with providers who had not experienced secondary stigma. The scale provides a contextualised tool to assess healthcare providers' attitudes toward MSM in Kenya and countries in SSA with similar cultural norms.
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Affiliation(s)
- Sylvia Shangani
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Becky Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Jennifer Pellowski
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Juddy Wachira
- Moi University, College of Health Sciences, School of Medicine, Department of Mental Health and Behavioral Social Sciences, Eldoret Kenya
| | - Violet Naanyu
- Moi University, School of Arts and Social Sciences, Eldoret, Kenya
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University, School of Public Health, Providence, Rhode Island, USA
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Wiginton JM, Murray SM, Poku O, Augustinavicius J, Jackman KMP, Kane J, Billong SC, Diouf D, Ba I, Mothopeng T, Njindam IM, Turpin G, Tamoufe U, Sithole B, Zlotorzynska M, Sanchez TH, Baral SD. Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries. BMC Public Health 2021; 21:2206. [PMID: 34861835 PMCID: PMC8641177 DOI: 10.1186/s12889-021-12151-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. METHODS We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d'Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. RESULTS Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. CONCLUSIONS Research to determine the factors driving disclosure's differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.
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Affiliation(s)
- John Mark Wiginton
- grid.21107.350000 0001 2171 9311Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Sarah M. Murray
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Ohemaa Poku
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jura Augustinavicius
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Kevon-Mark Phillip Jackman
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jeremy Kane
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY USA
| | - Serge C. Billong
- grid.412661.60000 0001 2173 8504Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon
| | | | | | | | - Iliassou Mfochive Njindam
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Gnilane Turpin
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Ubald Tamoufe
- grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | | | - Maria Zlotorzynska
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Travis H. Sanchez
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Stefan D. Baral
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
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Nakiganda LJ, Bell S, Grulich AE, Serwadda D, Nakubulwa R, Poynten IM, Bavinton BR. Understanding and managing HIV infection risk among men who have sex with men in rural Uganda: a qualitative study. BMC Public Health 2021; 21:1309. [PMID: 34218799 PMCID: PMC8254907 DOI: 10.1186/s12889-021-11365-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Same-sex sexual relations are criminalised in Uganda, and men who have sex with men (MSM) experience a high burden of HIV infection. In Uganda, health promotion policies focus on equity in healthcare and creating enabling environments. At present there is limited evidence upon which to enhance engagement of MSM in rural settings into effective HIV prevention. To fill this gap, our study explored MSM’s understandings of HIV risk and strategies used to reduce HIV risk in their sexual lives. Methods In-depth interviews were conducted with sixteen MSM in rural communities in Southwestern Uganda. Inductive thematic analysis examined men’s perceptions of HIV risk and strategies of reducing their own HIV risks. Results Understandings of HIV risk and risk practices were framed by lack of access to condoms, challenges negotiating condom and pre-exposure prophylaxis (PrEP) use, and condomless sex being reported as more pleasurable than sex with condoms. Strategies men perceived as enabling them to manage HIV risk included: PrEP use; condom use; knowing partners’ HIV status; avoiding partners associated with HIV risk; oral sex; withdrawal before ejaculation and washing one’s penis after sex. There were several misconceptions arising from poor HIV prevention knowledge. Strategies reliant on communication and negotiation with sexual partners were inhibited by gendered powered imbalances. Conclusions Our findings illustrate that MSM in rural settings in Uganda are making concerted efforts to implement strategies that might reduce risk of HIV transmission and infection within their sexual relationships. Key HIV health promotion and service-related strategies to support MSM with these efforts include an effective condom and lubricant supply chain; a PrEP program in trusted local health units, implemented via discreet community-outreach mechanisms; and same-sex specific HIV-related health promotion.
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Affiliation(s)
| | - Stephen Bell
- UQ Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia.,Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | | | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda.,Makerere University School of Public Health, Kampala, Uganda
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Criminalization of Sexual and Gender Minorities and Its Consequences for the HIV Epidemic in Zambia: A Critical Review and Recommendations. J Assoc Nurses AIDS Care 2021; 32:423-441. [PMID: 34115722 DOI: 10.1097/jnc.0000000000000281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT To elaborate the negative impacts of sexual and gender minority (SGM)-related legislation for the HIV epidemic in Zambia, we reviewed Zambian legislation that restricts the rights of SGM people and synthesized its consequences. We retrieved legal documents through the National Assembly of Zambia and the Zambia Legal Information Institute and conducted a critical review based on four academic databases following thematic synthesis methodology. Eighteen literature records and six Zambian laws were included in the review. Existing laws criminalize same-sex sexual behavior and restrict same-sex marriage and the adoption of children. Anti-SGM legislation has limited legal protections for SGM people and increased vulnerability of criminal prosecution and HIV exposure, persistent stigma/discrimination, insufficient public health resources, and lessened access to HIV-related services. We recommend enacting legal protections for SGM people, decriminalizing anti-SGM laws, rectifying misinformation to destigmatize SGM people, targeting health care for SGM people, and including SGM people in the national HIV strategy.
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Dunbar W, Labat A, Raccurt C, Sohler N, Pape JW, Maulet N, Coppieters Y. A realist systematic review of stigma reduction interventions for HIV prevention and care continuum outcomes among men who have sex with men. Int J STD AIDS 2021; 31:712-723. [PMID: 32631213 DOI: 10.1177/0956462420924984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living.
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Affiliation(s)
- Willy Dunbar
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Aline Labat
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christian Raccurt
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Nancy Sohler
- Community Health and Social Medicine, City University of New York, School of Medicine, New York, NY, USA
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Nathalie Maulet
- Ecole de Santé Publique, Université Catholique de Louvain, Brussels, Belgium
| | - Yves Coppieters
- Health Systems and Policies - International Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Mgopa LR, Rosser BRS, Ross MW, Lukumay GG, Mohammed I, Massae AF, Leshabari S, Mkonyi E, Mushy SE, Mwakawanga DL, Trent M, Wadley J, Bonilla ZE. Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals' experiences and health students' perspectives. BMC Public Health 2021; 21:676. [PMID: 33827508 PMCID: PMC8028207 DOI: 10.1186/s12889-021-10696-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/18/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health care providers across sub-Saharan Africa continue to face challenges while delivering sexual health care services. We explored the experiences, views and challenges of health care professionals and health students across different disciplines in Tanzania, towards delivery of sexual health services to men who have sex with men. METHODS Utilizing a qualitative approach, we recruited 121 health care professionals (providers) and students from the fields of midwifery, nursing and medicine in Dar es Salaam, Tanzania. We conducted 18 focus groups discussions, stratified by profession and experience, to investigate clinical management and challenges while addressing a case of an adult male presenting with rectal gonorrhea. RESULTS Findings indicated this case as extremely sensitive, clinical management involved establishing rapport and consent, medical care from history taking to treatment, and referral to other specialties. However, the illegal status of homosexuality in Tanzania was a primary concern to participants, this triggered the clinical care of this case scenario as challenging. There were uncertainties whether or not that such a case should be reported to the authorities. CONCLUSION Findings from this study revealed a need for training health students in Tanzania to address sexual health issues including accurate information on homosexuality, reporting requirements and clinical management in the legal and socio-cultural context of the African continent.
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Affiliation(s)
- Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B R Simon Rosser
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA.
| | - Michael W Ross
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Gift Gadiel Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohammed
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
| | | | - Dorkasi L Mwakawanga
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Maria Trent
- Johns Hopkins University, Washington, DC, USA
| | - James Wadley
- Lincoln University, Counseling and Human Services Department, 1570 Baltimore Pike, Philadelphia, PA, 19352, USA
| | - Zobeida E Bonilla
- University of Minnesota, School of Public Health, 1300 S. 2nd St., Minneapolis, MN, 55454, USA
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13
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Mulqueeny DM, Nkabini SM, Pokiya MH. Mapping evidence of depression in HIV-seropositive MSM in sub-Saharan Africa: a scoping review protocol. Syst Rev 2021; 10:50. [PMID: 33546768 PMCID: PMC7866456 DOI: 10.1186/s13643-021-01604-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is one of the most prevalent mental disorders among an estimated 25.6 million people living with HIV (PLHIV) in sub-Saharan Africa (SSA). The depression rate is higher in HIV-seropositive men who have sex with men (MSM) regardless of their sexual orientation, identity or romantic attraction. This is due to various types of stigma including HIV-related stigma, social stigma, self-stigma and mental health stigma. Opportunistic infections, unemployment, poverty and food insecurity also predispose HIV-seropositive MSM to depression. Moreover, depression in heterosexual and sexual minority groups challenges and additionally burdens SSA health care systems due to inadequate economic developments, lack of mental health professionals who specialise in the treatment of depression, few MSM-centred facilities, inadequate mental health infrastructure (hospitals and clinics) and complimentary resources. Although studies have highlighted links between mental health disorder, an HIV diagnosis and sexual minority groups, there is limited research that focusses on depression and its causal factors in MSM living with HIV in SSA. Hence, the relevance of conducting this scoping review. METHODS A scoping review guided by Arksey and O'Malley's framework, the enhancements and recommendations of Levac, Colquhoun and O'Brien, Daudt and associates and the 2015 Johanna Briggs Institute's guidelines will be conducted. Systematic electronic searches of databases and search engines such as Google, Google Scholar, CINAHL (EBSCOhost), MEDLINE (Ovid), and PsycInfo (Ovid) will be conducted to attain published peer-reviewed articles of all study designs. Grey literature will be sourced from media and conference abstracts and reports, governmental reports and unpublished dissertations and theses. Additionally, websites of humanitarian organisations and other relevant departmental websites will also be searched. Literature published between 2010 and 2020 that meets the review's inclusion criteria, research question and sub-question will be included in this review. All the retrieved literature will be exported to an Endnote X9.2 library after duplicates have been removed. DISCUSSION We anticipate mapping relevant literature on depression and the causal factors in HIV-seropositive MSM living in SSA. Once analysed and summarised, the data will be useful in identifying literature gaps, informing systematic reviews and future research. The findings could also assist in depression and sexuality dialogues, and awareness campaigns that address mental health issues, stigma and discrimination among this key population living in SSA.
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Affiliation(s)
- Delarise M. Mulqueeny
- Department of Social Work, Faculty of Arts, University of Zululand, Private Bag X1001, KwaDlangezwa, 3886 South Africa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Senzelokuhle M. Nkabini
- Department of Social Science, Gender and Education, School of Education, University of KwaZulu-Natal, Room 01-032, 121 Marianhill Rd, Pinetown, 3605 South Africa
| | - Manduleli H. Pokiya
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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14
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Ross MW, Kashiha J, Mgopa LR. Stigmatization of men who have sex with men in health care settings in East Africa is based more on perceived gender role-inappropriate mannerisms than having sex with men. Glob Health Action 2020; 13:1816526. [PMID: 32985387 PMCID: PMC7534303 DOI: 10.1080/16549716.2020.1816526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Healthcare Workers may stigmatize and discriminate against Men who have Sex with Men in East Africa. Objective: To understand the predictors of abuse and discrimination of sexual minority men in healthcare settings by Healthcare workers in seven cities in Tanzania. Method: In total, 300 sexual minority men over the age of 18 were interviewed in 7 Tanzanian cities by trained local interviewers. Abuse from others (physical, verbal, sexual, discrimination/humiliation), and abuse from Healthcare workers, was ascertained. Gender role mannerisms were self-rated by the respondent, and at the end of the interview, by the interviewer, on a Likert scale from very feminine to very masculine. Respondents also indicated whether they had revealed their homosexual behavior or had it exposed in the health consultation. Results: Median age was 27. Verbal abuse and community discrimination were the most commonly reported forms of abuse. Eighty-four percent had visited a healthcare center with a sexually related complaint (usually a sexually transmitted infection); of these, 24% reported abuse or discrimination from from a healthcare worker. Correlation between self-rated gender role mannerisms and interviewer-rated was r = 0.84. Regression analysis indicated that the degree of perceived gender role nonconformity was the major and significant predictor from Healthcare worker abuse: confirmation of homosexual behavior was non-significant. Gender role nonconformity predicted 21% of the variance in health worker abuse. Conclusion: There is speculation that abuse of sexual minority men by Healthcare workers in public clinics is due to factors in addition to their sexual behavior as gay/bisexual, and that it is due to violating perceived gender roles. Data confirm that perceived feminine gender role is a significant predictor, of abuse in healthcare and other settings. Common confusion between homosexual behavior and gender role norms may trigger discrimination, which may be as much due to violation of perceived gender roles as having sex with other men.
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Affiliation(s)
- Michael W Ross
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School , Minneapolis, MN, USA
| | | | - Lucy R Mgopa
- Department of Psychiatry, Muhimbili University of Health Sciences , Dar Es Salaam, Tanzania
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15
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Rosser BRS, Mgopa L, Leshabari S, Ross MW, Lukumay GG, Massawe A, Mkonyi E, Mohammed I, Mushy S, Mwakawanga D, Trent M, Wadley J. Legal and Ethical Considerations in the Delivery of Sexual Health Care in Tanzania. AFRICAN JOURNAL OF HEALTH, NURSING AND MIDWIFERY 2020; 3:84-102. [PMID: 34723251 PMCID: PMC8553133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Tanzania is a country with multiple sexual health challenges including high rates of HIV/STIs, early sexual debut, forced sex, sexual dysfunction, and teen pregnancy. Training in sexual health care is limited, while courses on how to address the ethical aspects of sexual health are non-existent. To address this gap, this paper explores legal and ethical challenges to providing sexual health care in Tanzania. First, we describe the sexuo-cultural and epidemiologic challenges, and the key laws regulating sexual health. Six case studies identify ethical dilemmas in healthcare delivery. They are: (a) how to address sexual and intimate partner violence; (b) treatment of illegal or stigmatized key populations; (c) treatment of couples in HIV serodiscordant, non-monogamous, and/or polygamous relationships; (d) requests for and participation in illegal healthcare; (e) treatment of women and children in the presence of their husbands and fathers; and (f) addressing child sexual abuse. We apply the ethical principles of autonomy, justice, beneficence and non-malfeasance. A second challenge is ensuring confidentiality in a setting where medical record keeping practices vary widely, and violations to confidentiality are perceived as common. Finally, we identify a set of best practices in sexual healthcare delivery tailored to the Tanzanian context.
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Affiliation(s)
- B R Simon Rosser
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Lucy Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Michael W Ross
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Agnes Massawe
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Inari Mohammed
- University of Minnesota, School of Public Health, 1300 S. 2 St. #300 Minneapolis, MN, USA
| | - Stella Mushy
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Dorkas Mwakawanga
- Muhimbili University of Health and Allied Sciences (MUHAS), School of Public Health and Social Sciences, PO Box 65015, Dar es Salaam, Tanzania
| | - Maria Trent
- Johns Hopkins Medicine, 615 N. Wolfe St., Baltimore, MD 21205, Washington, DC, USA
| | - James Wadley
- Lincoln University, School of Adult and Continuing Education, 1570 Baltimore Pike, Lincoln University, PA, USA
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16
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Rambarran N, Goodman J, Simpson J. Providing Care to LGBT Patients in Guyana: An Assessment of Medical Providers' Knowledge, Attitudes and Readiness to Learn. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2020; 33:18-28. [PMID: 38596475 PMCID: PMC10807803 DOI: 10.1080/19317611.2020.1846656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 04/11/2024]
Abstract
This study investigated the knowledge, attitudes and desire for continued education among Guyanese doctors with regards to LGBT health. It utilized a mixed methodology of quantitative, self-administered online surveys among 90 doctors, and qualitative semi-structured individual interviews with 8 other doctors. Descriptive and analytic calculations were performed on the quantitative data while thematic analysis was used for the qualitative data. The results show moderate knowledge levels regarding LGBT health, with deficits in awareness of LGBT health disparities; generally nondiscriminatory attitudes; and suboptimal education on LGBT health. Further training and pre-service curricular changes are necessary to address gaps and improve competency.
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Affiliation(s)
| | - Jeffrey Goodman
- LGBT Health Policy and Practice, George Washington University, Washington, DC, USA
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17
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Mutanga O, Moen K. The push of stigma: a qualitative study on the experiences and consequences of sexuality stigma among same-sex attracted men in Harare, Zimbabwe. CULTURE, HEALTH & SEXUALITY 2020; 22:1269-1281. [PMID: 31661668 DOI: 10.1080/13691058.2019.1674920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
This paper describes experiences of sexuality stigma among same-sex attracted men in Zimbabwe and analyses the consequences of such experiences for healthcare seeking. It draws on qualitative research carried out in Harare in 2017, which included in-depth interviews with sixteen gay and bisexual men, and key informant interviews with three representatives of organisations that work with gay men. There were numerous stories about sexuality stigma in the study participants´ social environments, including at home, in local communities and in healthcare facilities. We first offer a description of these and then go on to trace the implications of stigma on the relations between men who have sex with men on the one hand and the healthcare sector on the other. We conceive of stigma as a pushing force that exerts pressure on and in these relations, and identify five types of consequences of this. Stigma works to (1) produce geographical shifts in healthcare, (2) promote private over public care, (3) compartmentalise healthcare (with dedicated providers for queer persons), (4) deprofessionalise care, and (5) block access to appropriate healthcare altogether for some same-sex attracted men. Most of these consequences have negative implications for preventive or treatment-focused HIV programming.
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Affiliation(s)
- Oliver Mutanga
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, University of Oslo, Oslo, Norway
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18
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Dunbar W, Alcide C, Raccurt C, Pape JW, Coppieters Y. Attitudes of medical students towards men who have sex with men living with HIV: implications for social accountability. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:233-239. [PMID: 33099520 PMCID: PMC7882130 DOI: 10.5116/ijme.5f87.39c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the attitudes that medical students in Haiti harbour toward Men who have Sex with Men living with HIV in order to better understand how stigma and other factors may impair healthcare, and to explore suggestions of opportunities in line with the values of social accountability. METHODS This study employed a qualitative design by using a grounded theory approach regarding the context of Haiti. We used purposive sampling to select the 22 research participants. In-depth interviews were conducted, audio-recorded, transcribed and analyzed using an inductive content analysis approach. RESULTS Although stigmatizing attitudes emerged through the findings, medical students expressed willingness to provide Men who have Sex with Men with adequate health services in relation to HIV care. Their expressions were based on the Men who have Sex with Men's comprehensive right to receive equitable care, the moral responsibility of healthcare professionals, their perception of health disparities and the HIV global risk reduction. Participants pointed out that the medical education curriculum did not consider sexual health and specificities of sexual minorities and suggested a more inclusive and socially accountable training based on equity and quality. CONCLUSIONS The students expressed favourable attitudes regarding health services to Men who have Sex with Men even though some layered stigmatizing attitudes emerged through the discussions. They all lacked skills on how to handle health specificities of sexual minorities. These findings recommend a revision of the medical education curriculum in regard to social accountability principles.
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Affiliation(s)
- Willy Dunbar
- Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Colette Alcide
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Christian Raccurt
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
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19
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Bien-Gund CH, Zhao P, Cao B, Tang W, Ong JJ, Baral SD, Bauermeister JA, Yang LG, Luo Z, Tucker JD. Providing competent, comprehensive and inclusive sexual health services for men who have sex with men in low- and middle-income countries: a scoping review. Sex Health 2020; 16:320-331. [PMID: 31213225 DOI: 10.1071/sh18191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
Although men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmissible infections, sexual health services for MSM in low- and middle-income countries (LMIC) remain under-resourced and are poorly understood. A scoping review of literature on MSM sexual health in LMIC was conducted in order to identify key clinical services and gaps in knowledge. Three databases were searched, in addition to hand-reviewing key journals and bulletins, to identify literature with a focus on MSM sexual health. Key services related to providing care to MSM in LMIC that emerged from our review are described. These services include creation of safe and confidential clinic environments, HIV testing services, behavioural interventions, HIV pre-exposure prophylaxis (PrEP), rapid antiretroviral therapy (ART) initiation and STI services. Compared with high-income settings, major differences in LMIC include lack of diagnostic technology, unfavourable legal environments and lack of funding for MSM health. Innovative approaches to healthcare delivery, such as harnessing mobile technology, self-testing and crowdsourcing interventions, can improve health services among MSM in LMIC. There are gaps in the evidence about how best to provide sexual health services for MSM in LMIC settings. Implementation research and scale-up of existing biomedical and behavioural interventions, such as HIV/STI testing services, PrEP and early antiretroviral initiation are urgently needed in LMIC.
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Affiliation(s)
- Cedric H Bien-Gund
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Peipei Zhao
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, 3688 Nanhai Avenue, Shenzhen 518060, China
| | - Weiming Tang
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC 27516, USA
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, 418 Curie Boulevard, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Li-Gang Yang
- Guangdong Provincial STD Control Center, No. 2 Lujing Road, Guangzhou 510095, China
| | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, No. 8 Longyuan Road, Shenzhen 510855, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou 510095, China; and Social Entrepreneurship to Spur Health, No. 2 Lujing Road, Guangzhou 510095, China; and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; and Institute of Global Health and Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599, USA; and Corresponding author.
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20
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Ekouevi DK, Bitty-Anderson AM, Gbeasor-Komlanvi FA, Konu YR, Sewu EK, Salou M, Dagnra CA. Low prevalence of syphilis infection among key populations in Togo in 2017: a national cross-sectional survey. ACTA ACUST UNITED AC 2019; 77:39. [PMID: 31508231 PMCID: PMC6727363 DOI: 10.1186/s13690-019-0365-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/09/2019] [Indexed: 11/18/2022]
Abstract
Background The World Health Organisation (WHO) recommends the screening of syphilis among populations highly exposed to HIV. However, data on the prevalence of syphilis in these populations are scarce in Togo. This study aimed at estimating the prevalence of syphilis among males who have sex with males (MSM), female sex workers (FSW) and drug users (DU) in Togo. Methods A cross-sectional bio-behavioral study was conducted in August and September 2017 using a respondent-driven sampling (RDS) method in eight major cities in Togo. A standardized questionnaire was used to record socio-demographic data and sexual behavior patterns. A blood sample was taken and SD Bioline Duo VIH/Syphilis rapid test was used to test for HIV and syphilis. Results A total of 2158 key populations (678 MSM, 1003 FSW and 477 DU), with an average age of 27.6 years (standard deviation 8.8 years) participated in the study. Prevalence of syphilis was 0.6% (95% CI = [0.3–1.0]) with no statistical significance between the three groups: null among MSM, 0.8% among FSW (95% CI = [0.37–1.63]) and 1.1% among DU (95% CI = [0.39–2.57]). There was no relation between HIV status and syphilis (p = 0.236). Among the 298 HIV-positive people, none was diagnosed with syphilis. Conclusions Findings from this study reveal a low prevalence rate of syphilis among key populations in Togo. Specific interventions into HIV prevention programs should be reinforced to eliminate syphilis in Togo.
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Affiliation(s)
- Didier K Ekouevi
- 1Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo.,2Université de Bordeaux, Institut de Santé Publique Epidémiologie Développement (ISPED), Bordeaux, France.,3Programme PACCI - Site ANRS Côte d'Ivoire, CHU de Treichville, Abidjan, Côte d'Ivoire.,4INSERM U1219 Bordeaux Population Health Research, ISPED, Université de Bordeaux, Bordeaux, France.,Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | | | - Fifonsi A Gbeasor-Komlanvi
- 1Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo.,Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Yao R Konu
- 1Faculté des Sciences de la Santé, Département de Santé Publique, Université de Lomé, Lomé, Togo
| | - Essèboè K Sewu
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Mounerou Salou
- 6Laboratoire de Biologie Moléculaire, Département des Sciences Fondamentales, Université de Lomé, Lomé, Togo
| | - Claver A Dagnra
- 6Laboratoire de Biologie Moléculaire, Département des Sciences Fondamentales, Université de Lomé, Lomé, Togo.,Programme National de Lutte contre le VIH/Sida et les Infections Sexuellement Transmissibles (PNLS/IST), Lomé, Togo
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21
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Tellier PP. The impact on mental and physical health of human rights as they relate to gender and sexual minority adolescents and emerging adults. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTHCARE 2017. [DOI: 10.1108/ijhrh-01-2017-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to discuss the human rights issues pertinent to adolescents of diverse sexual orientation and gender identities and the health consequences resulting for the transgression of these rights. In 1948, the United Nations General Assembly passed a resolution endorsing the Universal Declaration of Human Rights. Yet, 73 member states criminalize the activities of these individuals. The other member states do not impose legal penalties on these activities, yet sexual and gender minority youth within these states continue to experience acts of physical and psychological aggression.
Design/methodology/approach
A commissioned position paper grounded in a convenient scholarly literature review on this topic.
Findings
Human rights transgressions by states or individuals lead to minority stress affecting the mental health and physical health of these youth.
Originality/value
The author makes a number of recommendations to address some of the impact resulting from the transgression of human rights in the world.
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Hagopian A, Rao D, Katz A, Sanford S, Barnhart S. Anti-homosexual legislation and HIV-related stigma in African nations: what has been the role of PEPFAR? Glob Health Action 2017; 10:1306391. [PMID: 28580879 PMCID: PMC5496073 DOI: 10.1080/16549716.2017.1306391] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Gay men and other men who have sex with men are disproportionately burdened by HIV infection. Laws that penalize same-sex intercourse contribute to a cycle of stigma, homonegativity and discrimination. In many African nations, laws criminalizing homosexuality may be fueling the epidemic, as they dissuade key populations from seeking treatment and health care providers from offering it. OBJECTIVES We analyzed the ways in which policies and practices of the US President's Emergency Plan for AIDS Relief (PEPFAR) program addressed pervasively harsh anti-homosexuality laws across Africa. Given the aim of the US PEPFAR program to reduce stigma surrounding HIV, we explored how PEPFAR may have used its influence to reduce the criminalization of homosexuality in the countries where it operated. METHODS We assessed homosexuality laws in 21 African countries where PEPFAR funding sought to reduce the HIV epidemic. We examined PEPFAR Policy Framework agreements associated with those countries, and other PEPFAR documents, for evidence of attempts to reduce stigma by decriminalizing homosexuality. RESULTS We found 16 of Africa's 21 PEPFAR-funded countries had laws characterized as harsh in relation to homosexuality. Among the top eight PEPFAR-funded countries in Africa, seven had harsh anti-homosexuality laws. Most (14) of the 16 African 'Partnership Framework' (PEPFAR) policy agreements between African governments and the US State Department call for stigma reduction; however, none call for reducing penalties on individuals who engage in homosexual behavior. CONCLUSIONS We conclude that while PEPFAR has acknowledged the negative role of stigma in fueling the HIV epidemic, it has, so far, missed opportunities to explicitly address the role of the criminalization of homosexuality in feeding stigmatizing attitudes. Our analysis suggests mechanisms like PEPFAR Partnership Framework agreements could be ideal vehicles to call for removal of anti-homosexuality legislation.
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Affiliation(s)
- Amy Hagopian
- Department of Health Services, University of Washington School of Public Health
| | - Deepa Rao
- Department of Global Health, University of Washington School of Public Health, Seattle, Washington
| | - Aaron Katz
- Department of Health Services, University of Washington School of Public Health
| | | | - Scott Barnhart
- Department of Global Health, University of Washington School of Public Health, Seattle, Washington
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Ross MW, Larsson M, Nyoni JE, Agardh A. Prevalence of STI symptoms and high levels of stigma in STI healthcare among men who have sex with men in Dar es Salaam, Tanzania: a respondent-driven sampling study. Int J STD AIDS 2016; 28:925-928. [PMID: 27913795 DOI: 10.1177/0956462416683625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Symptoms of sexually transmitted infections (STIs), whether they are presented for treatment or diagnosis, and how they are received by the clinician where they are presented, may be concomitants of stigma associated with homosexuality in homophobic climates. We analyzed respondent-driven sampling data from a study on 200 young men who have sex with men (MSM) in Dar es Salaam, Tanzania to examine sample prevalence, treatment and clinician response to 10 symptoms potentially associated with STIs. Survey measures included 10 self-reported STI symptoms, further specified according to location (genital, anal, oral), further specified according to place of diagnosis, place of, treatment whether there was pharmacy treatment or self-medication, healthcare worker (HCW) inquiries about source of infection and whether the HCW was polite. Most common symptoms reported were genital pain, burning urination, genital itching/burning, penile discharge, and groin swelling. Anal symptoms had the lowest proportion of treatment at public clinics and among the highest proportion of pharmacy treatment; anal sores had the highest proportion of self-medication. HCWs were reported as not being polite in response to 71-90% of the symptoms, (median = 82%). The findings suggest that stigma and negative HCW response are barriers to public clinic treatment for MSM in Tanzania and that these may have implications for both STI treatment and the HIV cascade.
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Affiliation(s)
- Michael W Ross
- 1 Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Markus Larsson
- 2 Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Joyce E Nyoni
- 3 Department of Anthropology and Sociology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Anette Agardh
- 2 Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Ross MW, Larsson M, Jacobson J, Nyoni J, Agardh A. Social networks of men who have sex with men and their implications for HIV/STI interventions: results from a cross-sectional study using respondent-driven sampling in a large and a small city in Tanzania. BMJ Open 2016; 6:e012072. [PMID: 27864245 PMCID: PMC5129084 DOI: 10.1136/bmjopen-2016-012072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Men who have sex with men (MSM) in sub-Saharan Africa remain hidden and hard to reach for involvement in HIV and sexually transmitted infection (STI) services. The aim of the current study was to describe MSM social networks in a large and a small Tanzanian city in order to explore their utility for peer-based healthcare interventions. METHODS Data were collected through respondent-driven sampling (RDS) in Dar es Salaam (n=197) and in Tanga (n=99) in 2012 and 2013, using 5 and 4 seeds, respectively. All results were adjusted for RDS sampling design. RESULTS Mean personal network size based on the number of MSM who were reported by the participants, as known to them was 12.0±15.5 in Dar es Salaam and 7.6±8.1 in Tanga. Mean actual RDS network size was 39.4±31.4 in Dar es Salaam and 25.3±9.7 in Tanga. A majority (97%) reported that the person from whom they received the recruitment coupon was a sexual partner, close friend or acquaintance. Homophile in recruitment patterns (selective affiliation) was present for age, gay openness, and HIV status in Dar es Salaam, and for sexual identification in Tanga. CONCLUSIONS The personal network sizes and existence of contacts between recruiter and referral indicate that it is possible to use peer-driven interventions to reach MSM for HIV/STI interventions in larger and smaller sub-Saharan African cities. The study was reviewed and approved by the University of Texas Health Science Center's Institutional Review Board (HSC-SPH-10-0033) and the Tanzanian National Institute for Medical Research (NIMR/HQ/R.8a/Vol. IX/1088).
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Affiliation(s)
- Michael W Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Markus Larsson
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Joyce Nyoni
- Department of Sociology and Anthropology, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Anette Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Tucker A, Liht J, de Swardt G, Arendse C, McIntyre J, Struthers H. Efficacy of Tailored Clinic Trainings to Improve Knowledge of Men Who Have Sex with Men Health Needs and Reduce Homoprejudicial Attitudes in South Africa. LGBT Health 2016; 3:443-450. [PMID: 27835058 DOI: 10.1089/lgbt.2016.0055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE An urgent need exists for training on men who have sex with men (MSM) health needs at public health clinics across Africa. There is also a need to consider the impact of specific training for clinicians and clinic support staff, both of whom come into contact with MSM. Consideration must also be given to the relationship between two key outcomes of such training: increased knowledge regarding MSM and their health and reductions in homoprejudicial attitudes. METHODS This article explores the impact of training for clinicians and clinic support staff in the Western Cape, South Africa (n = 196), where some training modules were undertaken by both groups and some modules only by clinicians. Participants were evaluated at baseline and post-training on MSM knowledge and homoprejudicial attitudes. RESULTS After training, both clinicians and clinic support staff showed an increase in knowledge and a reduction in homoprejudicial attitude scores, with similar proportional improvements for both groups. Additional trainings for clinicians also resulted in significant improvements in their knowledge. However, reductions in homoprejudicial attitudes were related to the type of knowledge obtained. A threshold effect in post-training knowledge scores of 9 or greater on sensitivity material significantly increased the likelihood of a reduction in homoprejudicial attitudes. CONCLUSION These findings show that training for both types of clinic workers is important and effective, but facilitators should be mindful of complex relationships between knowledge and homoprejudicial attitudes.
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Affiliation(s)
- Andrew Tucker
- 1 Anova Health Institute , Johannesburg, South Africa .,2 Department of Environmental and Geographical Sciences, University of Cape Town , Cape Town, South Africa
| | - Jose Liht
- 3 Independent Researcher , Cambridge, United Kingdom
| | | | | | - James McIntyre
- 1 Anova Health Institute , Johannesburg, South Africa .,4 School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Helen Struthers
- 1 Anova Health Institute , Johannesburg, South Africa .,5 Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town , Cape Town, South Africa
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Wanyenze RK, Musinguzi G, Matovu JKB, Kiguli J, Nuwaha F, Mujisha G, Musinguzi J, Arinaitwe J, Wagner GJ. "If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda. PLoS One 2016; 11:e0147714. [PMID: 26808653 PMCID: PMC4726486 DOI: 10.1371/journal.pone.0147714] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the high HIV prevalence among men who have sex with men (MSM) in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda. METHODS In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software. RESULTS Three quarters of the MSM (n = 62, 72.9%) were not comfortable disclosing their sexual orientation to providers and 69 (81.1%) felt providers did not respect MSM. Half (n = 44, 51.8%) experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i) unwelcoming provider behaviours; (ii) limited provider skills and knowledge; (iii) negative community perceptions towards MSM; (iv) fear of being exposed as MSM; (v) limited access to MSM-specific services; (vi) high mobility of MSM, (vii) lack of guidelines on MSM health services; viii) a harsh legal environment; and ix) HIV related stigma. Two-thirds (n = 56, 66%) participated in MSM social networks and 86% of these (48) received support from the networks to overcome barriers to accessing services. CONCLUSIONS Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.
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Affiliation(s)
- Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph K. B. Matovu
- Department of Community Health, Makerere University School of Public Health, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | - Glenn J. Wagner
- RAND Corporation, Santa Monica, CA, United States of America
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The green shoots of a novel training programme: progress and identified key actions to providing services to MSM at Kenyan health facilities. J Int AIDS Soc 2015; 18:20226. [PMID: 26493863 PMCID: PMC4615801 DOI: 10.7448/ias.18.1.20226] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 09/13/2015] [Accepted: 09/20/2015] [Indexed: 12/12/2022] Open
Abstract
Introduction Although men who have sex with men (MSM) in sub-Saharan Africa are at high risk for HIV acquisition, access to and quality of health and HIV services within this population are negatively affected by stigma and capacity within the health sector. A recently developed online MSM training programme (www.marps-africa.org) was shown to contribute to reductions in MSM prejudice among healthcare providers (HCPs) in coastal Kenya. In this study, we used qualitative methods to explore the provision of MSM healthcare services two years post-training in coastal Kenya. Methods From February to July 2014, we held 10 focus group discussions (FGD) with 63 participants, including HCP from 25 facilities, county AIDS coordinators and MSM from local support groups. Participants discussed availability, acceptability and accessibility of HIV healthcare for MSM. HCP also discussed changes in their health service practices after completing the training. FGD were recorded, transcribed verbatim and analyzed using Ritchie and Spencer's “framework approach” for qualitative data. Results HCPs described continued improvements in their ability to provide service in a non-stigmatizing way to MSM patients since completing the training programme and expressed comfort engaging MSM patients in care. Four additional recommendations for improving MSM healthcare services were identified: 1) expanding the reach of MSM sensitivity training across the medical education continuum; 2) establishing guidelines to manage sexually transmitted anal infections; 3) promoting legal and policy reforms to support integration of MSM-appropriate services into healthcare; and 4) including MSM information in national reporting tools for HIV services. Conclusions Positive impacts of this sensitivity and skills training programme were reflected in HCP attitudes two years post-intervention. Scaling-up of efforts will rely on continued policies to include MSM in healthcare programmes to reduce stigma in health settings and guidelines for MSM STI service delivery.
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