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Anuga DW, Iddrisu M, Konlan KD. Self-reported life experiences of members of the LGBTQ+ community in Accra, Ghana. PLoS One 2025; 20:e0325148. [PMID: 40440283 PMCID: PMC12121748 DOI: 10.1371/journal.pone.0325148] [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: 11/28/2024] [Accepted: 04/30/2025] [Indexed: 06/02/2025] Open
Abstract
BACKGROUND Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+) community members encompass individuals whose sexual orientations and gender identities do not align with the heterosexual norms in society. Even though this population has gained increasing prominence worldwide, most societies particularly in sub-Saharan Africa (SSA) abhor these sexual orientations. We explored the self-reported life experiences of members of the LGBTQ+ community in Accra, Ghana. METHODS In this qualitative enquiry, we recruited fifteen (15) members of the LGBTQ+ community in Accra via purposive snowballing sampling technique. We conducted in-depth interviews using a pre-tested interview guide and the interviews were audio taped and transcribed verbatim. Thematic analysis was conducted with the aid of NVivo 10.0. RESULTS The participants recounted their experiences within their individual families, within the LGBTQ+ community, and their experiences with the public in Ghana and as well as within their extended families. The participants claimed that the general society (public) in Ghana stigmatizes against members of the LGBTQ+ community with most families rejecting members who claim to be LGBTQ+ persons. The participants however claimed that the LGBTQ+ community served as a major source of support for them and helped them cope with the rejection and stigma associated with their sexual orientations. They further claimed that the stigma and rejection contributed to poor mental health of most LGBTQ+ persons with most of them seeking asylum in more inclusive and welcoming jurisdictions. CONCLUSION Members of the LGBTQ+ community in Ghana face stigma and societal pressures in their families and public spaces, creating stress that contributes to mental health challenges. We recommend that the Government of Ghana through the Ministry of Gender, Children and Social Protection and the Ghana Health Service increases public education to improve cultural competence and inclusivity of this vulnerable population in society to reduce stigma and discrimination.
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Affiliation(s)
- Donald Womonia Anuga
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
| | - Merri Iddrisu
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
| | - Kennedy Dodam Konlan
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Greater Accra Region, Ghana
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Yan W, Xu D, Duan Q, Huang N, Han J, Shi Y, Li J, Liu H. Role of Individual and Network Factors in HIV Care Continuum Outcomes among PLWH: An Egocentric Network Study in Yunnan, China. AIDS Behav 2025; 29:1281-1293. [PMID: 39739286 DOI: 10.1007/s10461-024-04602-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2024] [Indexed: 01/02/2025]
Abstract
Due to limited data on the determinants of HIV care continuum outcomes among people living with HIV (PLWH) in resource-limited settings, this study aimed to identify individual and social support network factors influencing these outcomes, thereby informing the development of intervention strategies to achieve the UNAIDS 95-95-95 targets. PLWH in Yunnan, China, were recruited using convenience sampling at three stages of the HIV care continuum: linkage to care, antiretroviral therapy (ART) initiation, and viral suppression. An egocentric network design combined with multilevel logit modeling was employed to investigate factors associated with ART initiation and viral suppression. A total of 410 eligible participants were recruited into the study. Of these, 145 (35.4%) were linked to care but did not initiate ART, 265 (64.6%) initiated ART, and 131 (49.4%) achieved viral suppression. Higher trust in alters, larger network density, stronger social support, and longer ego-alter relationship were positively associated with ART initiation and viral suppression. Participants who received social support from friends or family members had higher odds of initiating ART compared to those who received support from sexual partners. Factors associated with viral suppression were larger network size, having older alters and alters with higher education in an ego's social support network. The findings enhance our understanding of how social support network determinants influence HIV care continuum outcomes. Interventions for PLWH in China should consider these social support network characteristics to improve outcomes.
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Affiliation(s)
- Wenjun Yan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Di Xu
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Qiongli Duan
- Center for Disease Control and Prevention in Honghe Hani and Yi Autonomous Prefecture, Mengzi, People's Republic of China
| | - Nengmei Huang
- Center for Disease Control and Prevention in Honghe Hani and Yi Autonomous Prefecture, Mengzi, People's Republic of China
| | - Jing Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yuhua Shi
- Yunnan Center for Disease Control and Prevention, Kunming, People's Republic of China.
| | - Jian Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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Apreku A, Abu-Ba'are GR, Dada D, Foster M, Stockton MA, Aidoo-Frimpong GA, Kuffour OFO, Adjei G, Manu A, Torpey K, Nyblade L, Nelson LE, Logie CH. Examining Experiences of Gender Identities, Roles, and Relations among Men with Same-Gender Sexual Histories: Implications of Gender Nonconformity on Access to Quality Healthcare in Urban Ghana. J Urban Health 2025; 102:413-422. [PMID: 40113725 PMCID: PMC12031717 DOI: 10.1007/s11524-025-00964-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2024] [Indexed: 03/22/2025]
Abstract
Globally, MSM experience severe health disparities, including an increased risk of HIV acquisition. In Ghana's urban centers, these disparities are influenced by intersectional stigma related to sexuality and gender nonconformity, yet limited research exists on the role of gender in driving stigma in the day-to-day interactions of MSM. This study is aimed at understanding (1) the experiences of gender identity and roles among MSM in Ghana and (2) how these experiences of gender shape daily urban life in Ghanaian social interactions, including interpersonal interactions in healthcare settings. We conducted a qualitative description using secondary data generated from focus groups and in-depth interviews with adult MSM and health care workers in Accra and Kumasi, Ghana. Data were analyzed using qualitative content analysis. We identified five factors that describe the experiences of gender roles, identities, and relations and identified one theme regarding the influence of gender on MSM daily life. First, understandings of gender roles were influenced by local binary gendered expectations regarding (1) appearance and presentation, (2) physical characteristics and personality traits, and (3) household and community responsibilities. The experience of gender identity was informed by perceptions of its (4) relationship to or (5) independence from physical anatomy. In Ghana, men's gender nonconformity and its linkages to discrimination are complex, context dependent, and evolving. The interplay between gender nonconformity and same-gender sex stigma undermines access to quality health care and threatens the well-being of Ghanaian MSM.
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Affiliation(s)
- Amos Apreku
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Gamji Rabiu Abu-Ba'are
- Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
- School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Debbie Dada
- School of Nursing, Yale University, 400 West Campus Drive, New Haven, CT, 06477, USA
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, USA
| | - Marcel Foster
- RTI International, 701 13Th Street NW., #750, Washington DC, 20005, USA
- Performance Hypothesis, LLC, 135 Auburn Avenue, NE, Suite 201, Atlanta, GA, 30303, USA
| | - Melissa A Stockton
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Gloria A Aidoo-Frimpong
- Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA
- Department of Epidemiology and Environmental Health, School of Public Health, University at Buffalo, 193 Farber Hall, Buffalo, NY, 14214, USA
| | | | | | - Adom Manu
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kwasi Torpey
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Laura Nyblade
- RTI International, 701 13Th Street NW., #750, Washington DC, 20005, USA
| | - LaRon E Nelson
- Center for Interdisciplinary Research On AIDS, School of Public Health, Yale University, 60 College Street, New Haven, CT, 06510, USA.
- School of Nursing, Yale University, 400 West Campus Drive, New Haven, CT, 06477, USA.
- School of Public Health, Yale Institute for Global Health, 1 Church Street, New Haven, CT, 06510, USA.
- Rotman School of Management, University of Toronto, 105 St. George Street, Toronto, ON, M5S 3E6, Canada.
| | - Carmen H Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
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Ouner JJ, Thompson RGA, Dey NEY, Alhassan RK, Gyamerah AO. Correlates of internalized stigma and antiretroviral therapy adherence among people living with HIV in the Volta region of Ghana. BMC Public Health 2025; 25:342. [PMID: 39871213 PMCID: PMC11773945 DOI: 10.1186/s12889-025-21500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Accepted: 01/16/2025] [Indexed: 01/29/2025] Open
Abstract
OBJECTIVE HIV-related stigma is a major public health concern compromising the rights and health outcomes of many people living with HIV (PLWH). Its reduction is said to be critical in strengthening the continuous efforts targeted at preventing and controlling HIV, as it directly impacts antiretroviral treatment adherence. This study examines the association between HIV-related stigma and adherence to antiretroviral therapy (ART) among PLWH in one of the 16 administrative regions of Ghana, Africa. METHODS This descriptive cross-sectional study employed a survey to assess the factors affecting the utilization of ART among PLWH (n = 155) in the Volta region. The Center for Support Evaluation adherence index and internalized stigma of AIDS Tool were used to collect data on medication adherence and stigma, respectively. Data was analyzed using R statistical analysis software. Logistic regression models were performed to ascertain the predictors of ART utilization among PLWH. RESULTS A greater proportion (70%) of the study's participants reported adherence to ART. We found a positive association between HIV-related internalized stigma and medication adherence such that reporting high levels of stigma on average was associated with high levels of medication adherence [OR = 1.08, 95% CI:1.01, 1.15]. Older age was related to higher adherence while reporting more depressive symptoms was associated with low medication adherence. CONCLUSION Our findings show that stigma may serve as a facilitator instead of a barrier to adhering to antiretroviral medication. Although this contradicts common narratives about stigma's destructive effect, it is possible to promote good health-seeking behavior when the fear component of stigma is considered. To encourage medication adherence towards meeting UNAIDS' 95-95-95 agenda and better understand stigma's role, further research is required.
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Affiliation(s)
- Jerry John Ouner
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Rachel G A Thompson
- Language Centre, College of Humanities, University of Ghana, legon, Accra, Ghana.
- Africa Interdisciplinary Research Institute, Accra, Ghana.
- Institute of Global Health Sciences, University of California San Francisco, San Francisco, CA, USA.
| | - Nutifafa E Y Dey
- Africa Interdisciplinary Research Institute, Accra, Ghana
- Department of Psychology, University of Ghana, Legon, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
- School of Health Sciences, University of Dundee, Dundee, Scotland, UK
| | - Akua O Gyamerah
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY, USA
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5
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Janek SE, Hatoum S, Ledbetter L, Relf MV. Understanding the Stigma Experience of Men Living with HIV in Sub-Saharan Africa: A Qualitative Meta-synthesis. AIDS Behav 2024; 28:2500-2533. [PMID: 38777917 PMCID: PMC11423389 DOI: 10.1007/s10461-024-04329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 05/25/2024]
Abstract
Men living with HIV (MLWH) in sub-Saharan Africa experience poor health outcomes and increased AIDS-related deaths due to stigma influencing testing and treatment uptake and adherence. PRISMA 2020 was used to report a meta-synthesis of the stigma experiences of MLWH in SSA. With the help of an expert librarian, a search of six databases was formulated and performed to examine the available qualitative and mixed method studies with qualitative results relevant to the research question. Studies focused on adult men living with HIV, with five studies specifically examining the HIV experience of men who have sex with men. Study themes were synthesized to describe MLWH's perceived, internalized, anticipated, enacted, and intersectional stigma experiences. Most studies included masculinity as a key theme that affected both testing and treatment adherence upon diagnosis. Future research is needed to better understand subpopulations, such as men who have sex with men living with HIV, and what interventions may be beneficial to mitigate the disparities among MLWH in SSA.
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Affiliation(s)
- Sarah E Janek
- School of Nursing, Duke University, 307 Trent Drive, Box 3322, Durham, NC, 27710, USA.
| | | | | | - Michael V Relf
- School of Nursing, Duke University, 307 Trent Drive, Box 3322, Durham, NC, 27710, USA.
- Duke Global Health Institute, Durham, NC, USA.
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Abu-Ba’are GR, Shamrock OW, Zigah EY, Ogunbajo A, Dakpui HD, Agbemedu GRK, Boyd DT, Ezechi OC, Nelson LE, Torpey K. Qualitative description of interpersonal HIV stigma and motivations for HIV testing among gays, bisexuals, and men who have sex with men in Ghana's slums-BSGH-005. PLoS One 2024; 19:e0289905. [PMID: 38837972 PMCID: PMC11152275 DOI: 10.1371/journal.pone.0289905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
Despite significant progress in Ghana's HIV response, disparities in HIV prevalence persist among different populations. Gays, bisexuals, and other men who have sex with men (GBMSM) in the country remain vulnerable to HIV infection due to high levels of stigma and discrimination, limited access to healthcare services, and low HIV knowledge levels. While limited studies focus on HIV prevention and care in the Ghanaian GBMSM context, we did not find studies on GBMSM in slums. We, therefore, explored stigma and motivations of HIV testing among GBMSM in slums. In collaboration with our community partners, we recruited and conducted face-to-face interviews among 12 GBMSM from slums in Accra and Kumasi, Ghana. Our multiple-reviewer summative content analysis identified the following: under HIV stigma, we identified two categories, avoidance of GBMSM living with HIV and fear of testing positive for HIV. Under motivations for HIV testing, we identified three categories; HIV vulnerability, knowing one's HIV status, and positive messaging about HIV. Our findings provide valuable insights into stigma and motivations for HIV testing among GBMSM in Ghanaian slums. They also highlight the importance of targeted HIV education interventions to empower GBMSM to take responsibility for their sexual health and address the unique challenges they face accessing HIV testing services.
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Affiliation(s)
- Gamji Rabiu Abu-Ba’are
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Osman Wumpini Shamrock
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - Edem Yaw Zigah
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - Adedotun Ogunbajo
- Us Helping Us People into Living, Washington, DC, United States of America
| | - Henry Delali Dakpui
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama’a Action, West Legon, Accra, Ghana
| | - Donte T. Boyd
- College of Social Work, Ohio State University, Columbus, Ohio, United States of America
| | - Oliver C. Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Aidoo-Frimpong G, Tong G, Akyirem S, Abwoye DN, Nwanaji-Enwerem U, López DJ, Wilton L, Nelson LE. Sociodemographic correlates of late HIV diagnosis among men who have sex with men (MSM) in Ghana. AIDS Care 2024; 36:807-815. [PMID: 38460152 DOI: 10.1080/09540121.2024.2325071] [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: 10/06/2023] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Abstract
Timely HIV diagnosis and medical engagement are crucial for effective viral load suppression and treatment as prevention. However, significant delays persist, particularly in Africa, including Ghana. This study focused on Ghanaian men whose route of exposure to HIV was through same-gender sexual contact (MSM), a group disproportionately impacted by HIV. Using structured surveys, we investigated the sociodemographic factors associated with late HIV diagnosis, a topic with limited existing research. Results indicate that older age groups were associated with an increased risk of late diagnosis compared to the 18-24 age group. Among the demographic variables studied, only age showed a consistent association with late HIV diagnosis. This study underscores the importance of targeted interventions to address HIV diagnosis disparities among MSM in Ghana, particularly for older age groups. The findings emphasize the need for tailored interventions addressing age-related disparities in timely diagnosis and engagement with medical services among this population. Such interventions can play a crucial role in reducing the burden of HIV within this community and fostering improved public health outcomes.
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Affiliation(s)
- Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Guangyu Tong
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | | | | | - Daniel Jacobson López
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- School of Social Work, Boston University, Boston, MA, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - LaRon E Nelson
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Yale School of Nursing, Yale University, New Haven, CT, USA
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8
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Abu-Ba'are GR, Torpey K, Guure C, Nelson LE, Jeon S, McMahon J, Leblanc NM, Shamrock OW, Zigah EY, Apreku A, Dakpui HD, Agbemedu GRK, Boakye F, Adu P, Attisoe A, Adjaka G. Status-neutral community-based multilevel intervention to address intersectional stigma and discrimination, and increase HIV testing, PrEP, and ART uptake among YGBMSM in Ghanaian Slums: A clustered randomized control trial protocol. RESEARCH SQUARE 2024:rs.3.rs-4486078. [PMID: 38854081 PMCID: PMC11160908 DOI: 10.21203/rs.3.rs-4486078/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background While GBMSM constitute less than 2% of Ghana's population, their HIV prevalence surpasses the national average by more than eightfold, emphasizing the critical need for targeted interventions to improve detection, care linkage, and reduce community transmission. This study seeks to increase HIV testing, Pre-Exposure Prophylaxis (PrEP), and Antiretroviral Therapy (ART) uptake (HPART) among YGBMSM through the adaptation of an evidence-based intervention (LAFIYA). Methodology We will employ the ADAPTT-IT framework to adapt LAFIYA and evaluate its feasibility and effectiveness in addressing intersectional stigma and increasing HPART uptake among YGBMSM residing in Ghanaian slums. In aim 1, we will hold focus groups (n=5) and interviews (n=20) among YGBMSM and two FGDs among GBMSM-led organizations. At the HCF level, we will hold 6 FGDs and interviews (n=20) among nurses. In AIM 2, we will randomly assign 6 healthcare facilities (HCFs) to receive the LAFIYA (n=3) or wait-list control (n=3). Friend groups (cluster) of YGBMSM (N=240) will be assigned to receive LAFIYA (n=120) or a wait-list control (n=120). We will collect 3-, 6-, and 9-months post-intervention data among YGBMSM(n=240) and HCWs(n=300) to measure HPART adherence (primary outcomes), ISD reduction, HIV and status-neutral knowledge (secondary outcomes), and intervention acceptability, appropriateness, and feasibility (implementation outcomes). Conclusion The intervention group will observe increased HPART adherence, reduced ISD, and enhanced HPART knowledge and efficacy relative to the wait-list control group. The findings will inform ISD reduction and HIV status-neutral implementation strategies - and place-based interventions that address access to HIV prevention and care among YGBMSM, slum and in different settings. Trail Registration This study was registered on clinicalTrail.gov, with identifier number NCT06312514 on 03/14/2023. https://classic.clinicaltrials.gov/ct2/show/NCT06312514.
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Affiliation(s)
- Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Sangchoon Jeon
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - James McMahon
- School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Natalie M Leblanc
- School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Osman Wumpini Shamrock
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Amos Apreku
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Henry Delali Dakpui
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, New York, USA
| | | | - Prince Adu
- Priorities on Rights and Sexual Health, Accra, Ghana
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9
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Shamrock OW, Abu-Ba'are GR, Zigah EY, Dakpui HD, Adjaka G, LeBlanc NM, Alio AP, Nelson L. Community stigma, victimization, and coping strategies among gay, bisexual, and other cis-gender men who have sex with men in slum communities in Ghana. BSGH-003. BMC Public Health 2024; 24:966. [PMID: 38580970 PMCID: PMC10998418 DOI: 10.1186/s12889-024-18242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Gay, bisexual, and cis-gender men who have sex with men (GBMSM) face severe consequences, especially within stigmatized environments. However, very little is known about the experiences of GBMSM living in slums in SSA and Ghana. This study investigates the experiences of stigma, victimization, and coping strategies and proposes some interventional approaches for combating stigma facing GBMSM in slum communities. METHODS We engaged GBMSM living in slums in two major Ghanaian cities. We used a time-location sampling and collected data through in-depth individual interviews. Two major themes emerged from the study: (1) insecurities and criminalization of GBMSM activity, and (2) GBMSM coping strategies. RESULTS Findings show GBMSM experienced negative attitudes from the community due to their sexual behavior/orientation. GBMSM also developed coping strategies to avert negative experiences, such as hiding their identities/behavior, avoiding gender non-conforming men, and having relationships with persons outside their communities. CONCLUSION We propose interventions such as HIV Education, Empathy, Empowerment, Acceptance, and Commitment Therapy as possible measures to improve the experiences of GBMSM living in Ghanaian slum communities.
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Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Gender Health Lab, Accra, Ghana
- Behavioral, Sexual and Gender Health Lab, University of Rochester, New Haven, Connecticut, USA
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Gender Health Lab, Accra, Ghana
- School of Public Health, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
- Behavioral, Sexual and Gender Health Lab, University of Rochester, New Haven, Connecticut, USA
| | | | | | - Gideon Adjaka
- Hope Alliance Foundation, Non-profit Organization, Accra, Ghana
| | - Natalie M LeBlanc
- School of Nursing, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Amina P Alio
- School of Public Health, University of Rochester, Rochester, USA
| | - LaRon Nelson
- School of Nursing, Yale University, West Haven, USA
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, USA
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Abu-Ba'are GR, Aidoo-Frimpong G, Amu-Adu P, Zigah EY, Stockton M, Amuah S, Amoh-Otoo RP, Nyblade L, Torpey K, Nelson LE. "One pastor advised him to stop taking HIV medication": Promoters and barriers to HIV care among gay, bisexual, and men who have sex with men living with HIV in Ghana. RESEARCH SQUARE 2024:rs.3.rs-4087718. [PMID: 38562846 PMCID: PMC10984093 DOI: 10.21203/rs.3.rs-4087718/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Introduction Few studies examine Ghanaian gay, bisexual, and other men who have sex with men (GBMSM) experience with HIV diagnoses and linkage to care. This article provides qualitative accounts of promoters and barriers to care among GBMSM living with HIV in Ghana. Methods We recruited and interviewed 10 GBMSM living with HIV in two Ghanaian cities. We transcribed the interviews, coded the data, and used thematic content analysis. Results We found that community and healthcare facility (HCF) level HIV and sexual stigma, confidentiality issues, alternative medicine, and substance use remain the key barriers to care. Other barriers include healthcare system issues such as long wait times and economic problems (e.g., health insurance and financial difficulties). Nonetheless, HCF-level factors such as positive experiences with providers, HIV counseling, and detailed medication information facilitate adherence to care among GBMSM. Conclusion This study highlights the need for interventions that address linkage to care issues, especially substance use, disinformation, and misinformation among GBMSM and other Ghanaian communities.
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Affiliation(s)
- Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester
| | | | | | - Edem Yaw Zigah
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester
| | | | - Samuel Amuah
- Youth Alliance for Health and Human Rights, YAHR
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Dada D, Abu-Ba'are GR, Turner D, Mashoud IW, Owusu-Dampare F, Apreku A, Ni Z, Djiadeu P, Aidoo-Frimpong G, Zigah EY, Nyhan K, Nyblade L, Nelson LE. Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa. BMJ Open 2024; 14:e078794. [PMID: 38346887 PMCID: PMC10862343 DOI: 10.1136/bmjopen-2023-078794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations. DESIGN Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. DATA SOURCES Public health and regional databases were searched in 2020 and 2022. ELIGIBILITY CRITERIA Articles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA. DATA EXTRACTION AND SYNTHESIS Articles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed. RESULTS Of 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors. CONCLUSION Intersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
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Affiliation(s)
- Debbie Dada
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Gamji R Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | | | | | | | | | - Zhao Ni
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Pascal Djiadeu
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
- School of Public Health, University of Toronto Dalla Lana, Toronto, Ontario, Canada
| | - Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Laura Nyblade
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
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12
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Aidoo-Frimpong G, Abu-Ba’are GR, Apreku A, Amoh-Otu RP, Zigah E, Amu-Adu P, Amuah S, Nyblade L, Torpey K, Nelson LE. "We have our reasons": Exploring the acceptability of pre-exposure prophylaxis among gay, bisexual, and other men who have sex with men in Ghana. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.05.23299515. [PMID: 38105990 PMCID: PMC10723517 DOI: 10.1101/2023.12.05.23299515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Ghanaian men who have sex with men (MSM) face significant HIV disparities. Pre-exposure prophylaxis (PrEP) is a highly effective tool for HIV prevention. Previous studies on the perspectives of PrEP use among Ghanaian MSM identified high interest in PrEP among this population. However, the knowledge from the previous research, which was the best available evidence at the time, was primarily hypothetical because those data were collected before any real-world implementation of PrEP in Ghana. The purpose of the analysis is to identify and understand the factors currently influencing PrEP acceptance. We conducted a secondary analysis of focus group (n=8) data with Ghanaian MSM. Audio transcripts were subjected to descriptive thematic analysis. There was an almost universal awareness of PrEP, but inaccuracies about PrEP were common. PrEP acceptability was influenced by a mix of individual and intrapersonal factors. To bridge the gap between awareness, knowledge, and acceptability, HIV prevention programs should address access barriers and incorporate community-derived strategies.
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Affiliation(s)
- Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT
| | - Gamji Rabiu Abu-Ba’are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Amos Apreku
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | | | - Edem Zigah
- Priorities on Rights and Sexual Health, Accra, Ghana
| | | | - Samuel Amuah
- Youth Alliance for Health and Human Rights, Kumasi, Ghana
| | | | - Kwasi Torpey
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT
- School of Nursing, Yale University, New Haven CT, USA
- Social and Behavioral Sciences Division, School of Public Health, Yale University, New Haven CT, USA
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Ranuschio B, Bell S, Waldron JM, Barnes L, Sheik-Yosef N, Villalobos E, Wackens J, Liboro RM. Promoting Resilience among Middle-Aged and Older Men Who Have Sex with Men Living with HIV/AIDS in Southern Nevada: An Examination of Facilitators and Challenges from a Social Determinants of Health Perspective. Healthcare (Basel) 2023; 11:2730. [PMID: 37893804 PMCID: PMC10606041 DOI: 10.3390/healthcare11202730] [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: 08/17/2023] [Revised: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Most prior research on resilience to HIV/AIDS among middle-aged and older men who have sex with men (MSM) has utilized quantitative methods that employ surveys and scales to measure constructs researchers have used to approximate the concept of resilience to HIV/AIDS. Only a few studies have purposively made efforts to incorporate the input of relevant stakeholders to guide their research on HIV/AIDS resilience and examine the perspectives and lived experiences of middle-aged and older MSM. To address this research gap, we conducted a community-based participatory research qualitative study to examine the perspectives and lived experiences of HIV-positive, middle-aged and older MSM from Southern Nevada in order to identify factors that promote such resilience. We conducted 16 semi-structured interviews with middle-aged and older MSM living with HIV/AIDS from January to April 2022. From our thematic analysis of our interviews, we identified factors that served as facilitators or challenges to the promotion of our participants' HIV/AIDS resilience. We discuss in this article both the facilitators and challenges to our participants' resilience-building as the key themes from our interviews. We recognized that the impacts of these factors were mediated by their strong influence on the social determinants of health that were explicitly relevant to our participants. We offer important insights based on our findings, which could be especially useful to future research on resilience to HIV/AIDS.
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Affiliation(s)
- Brandon Ranuschio
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Sherry Bell
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - John M. Waldron
- LGBTQIA+ Community Center of Southern Nevada (The Center), Las Vegas, NV 89101, USA;
| | - Lianne Barnes
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Nadia Sheik-Yosef
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Esmeralda Villalobos
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Janelle Wackens
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
| | - Renato M. Liboro
- Department of Psychology, College of Liberal Arts, University of Nevada, Las Vegas, NV 89154, USA; (B.R.); (S.B.); (L.B.); (N.S.-Y.); (E.V.); (J.W.)
- Centre for Addiction and Mental Health, Toronto, ON M5S 2S1, Canada
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14
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Zigah EY, Abu-Ba'are GR, Shamrock OW, Dakpui HD, Apreku A, Boyd DT, Nelson LE, Torpey K. "For my safety and wellbeing, I always travel to seek health care in a distant facility"-the role of place and stigma in HIV testing decisions among GBMSM - BSGH 002. Health Place 2023; 83:103076. [PMID: 37423093 DOI: 10.1016/j.healthplace.2023.103076] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
Gays, bisexuals, and all other men who have sex with men (GBMSM) are heavily impacted by HIV in Ghana compared to the general population. In addition to HIV and same-sex intercourse stigma, barriers such as reduced privacy, lower-income status and limited health care facilities (HCF) affect HIV testing decisions among GBMSM. We employed a phenomenological research design to understand the role of place and stigma in HIV testing among GBMSM in slums. GBMSM (n = 12) from slums in Accra and Kumasi, Ghana, were recruited and engaged in face-to-face interviews. We used a multiple reviewer summative content analysis to analyze and organize our key findings. The HIV testing options we identified include 1. Government HCF, 2. NGO and community outreach 3. Peer-educated services. Factors influencing GBMSM to test for HIV at HCF outside their areas included 1. The location of HCF 2. HIV and sexual stigma from slum areas 3. Positive HCW attitudes at distant HCF. 4. Negative Healthcare worker (HCW) attitudes towards GBMSM. These findings highlighted how stigma from slums and HCW influence HIV testing decisions and the need for place-based interventions to address stigma among HCW in slums to improve testing among GBMSM.
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Affiliation(s)
- Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana.
| | - Gamji Rabiu Abu-Ba'are
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana; Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA
| | - Osman Wumpini Shamrock
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA
| | - Henry Delali Dakpui
- Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- School of Public Health, University of Ghana, Accra, Ghana
| | - Donte T Boyd
- College of Social Work, Ohio State University, Columbus, OH, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA
| | - Kwasi Torpey
- School of Public Health, University of Ghana, Accra, Ghana
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15
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Kittle K, Boerner K, Kim K, Fredriksen-Goldsen K. The Role of Contextual Factors in the Health Care Utilization of Aging LGBT Adults. THE GERONTOLOGIST 2023; 63:741-750. [PMID: 36048185 PMCID: PMC10167762 DOI: 10.1093/geront/gnac137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Research suggests lesbian, gay, bisexual, and transgender (LGBT) populations have unique health care challenges. The purpose of this study was to understand contextual factors, including minority stress and social resources, associated with the health care utilization of LGBT middle-aged and older adults. RESEARCH DESIGN AND METHODS Using data from the Caring and Aging With Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression investigated associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and health care utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources (i.e., social network size, social support, and LGBT community belonging) in these associations. RESULTS Internalized stigma was negatively associated with having a routine checkup in the previous year. LGBT identity disclosure was positively associated with having a health screening within the past 3 years. Social support moderated the association between LGBT identity disclosure and health screenings. DISCUSSION AND IMPLICATIONS Health and human service professionals and their clients should be educated about the ways that LGBT identity disclosure can affect health care utilization. Providers should consistently assess the social support of their aging LGBT clients and inform them about the potential risk of low social support in health care utilization.
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Affiliation(s)
- Krystal R Kittle
- Department of Social and Behavioral Health Program, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Kathrin Boerner
- Department of Gerontology, University of Massachusetts, Boston, Massachusetts, USA
| | - Kyungmin Kim
- Department of Child Development and Family Studies, Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
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16
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Nelson LE, Ogunbajo A, Abu-Ba'are GR, Conserve DF, Wilton L, Ndenkeh JJ, Braitstein P, Dow D, Arrington-Sanders R, Appiah P, Tucker J, Nam S, Garofalo R. Using the Implementation Research Logic Model as a Lens to View Experiences of Implementing HIV Prevention and Care Interventions with Adolescent Sexual Minority Men-A Global Perspective. AIDS Behav 2023; 27:128-143. [PMID: 35947235 PMCID: PMC10191897 DOI: 10.1007/s10461-022-03776-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Adolescents and sexual minority men (SMM) are high priority groups in the United Nations' 2021 - 2016 goals for HIV prevention and viral load suppression. Interventions aimed at optimizing HIV prevention, testing and viral load suppression for adolescents must also attend to the intersectional realities influencing key sub-populations of SMM. Consequently, there is not a robust evidence-base to guide researchers and program partners on optimal approaches to implementing interventions with adolescent SMM. Using a multiple case study design, we integrated the Implementation Research Logic Model with components of the Consolidated Framework for Implementation Research and applied it as a framework for a comparative description of ten HIV related interventions implemented across five countries (Ghana, Kenya, Nigeria, Tanzania and United States). Using self-reported qualitative survey data of project principal investigators, we identified 17 of the most influential implementation determinants as well as a range of 17 strategies that were used in 90 instances to support intervention implementation. We highlight lessons learned in the implementation research process and provide recommendations for researchers considering future HIV implementation science studies with adolescent SMM.
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Affiliation(s)
- LaRon E Nelson
- School of Nursing, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
- Yale Institute of Global Health, Yale University, New Haven, CT, USA.
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA.
| | - Adedotun Ogunbajo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Gamji Rabiu Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA
- School of Nursing, University of Rochester, NY, Rochester, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Leo Wilton
- Department of Human Development, State University of New York at Binghamton, Binghamton, NY, USA
| | - Jackson Junior Ndenkeh
- Center for International Health, Ludwig Maximilian University of Munich, Munich, Germany
| | - Paula Braitstein
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dorothy Dow
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Renata Arrington-Sanders
- Division of Adolescent/Young Adult Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick Appiah
- Youth Alliance for Health & Human Rights, Ashanti, Kumasi, Ghana
| | - Joe Tucker
- Division of Infectious Diseases, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Soohyun Nam
- School of Nursing, Yale University, New Haven, CT, USA
| | - Robert Garofalo
- Division of Adolescent Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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17
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Laws and policies against MSM and HIV control in Africa. Lancet HIV 2023; 10:e148-e149. [PMID: 36623536 DOI: 10.1016/s2352-3018(22)00371-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
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18
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Saalim K, Amu-Adu P, Amoh-Otu RP, Akrong R, Abu-Ba’are GR, Stockton MA, Vormawor R, Torpey K, Nyblade L, Nelson LE. Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana. BMC Public Health 2023; 23:166. [PMID: 36694150 PMCID: PMC9872747 DOI: 10.1186/s12889-023-15087-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.
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Affiliation(s)
| | | | | | | | | | - Melissa A. Stockton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY USA
| | | | | | | | - LaRon E. Nelson
- Yale School of Nursing, New Haven, CT USA
- Yale Institute for Global Health, New Haven, CT USA
- Yale Center for Interdisciplinary Research on AIDS, New Haven, CT USA
- Yale School of Public Health, New Haven, CT USA
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Bhutada K, Chakrapani V, Gulfam FR, Ross J, Golub SA, Safren SA, Prasad R, Patel VV. Pathways Between Intersectional Stigma and HIV Treatment Engagement Among Men Who Have Sex with Men (MSM) in India. J Int Assoc Provid AIDS Care 2023; 22:23259582231199398. [PMID: 37701971 PMCID: PMC10501078 DOI: 10.1177/23259582231199398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/13/2023] [Accepted: 08/18/2023] [Indexed: 09/14/2023] Open
Abstract
In India and other low-and-middle-income countries, little is known about how intersectional stigma affects MSM engagement in ART. Informed by the Health Stigma and Discrimination Framework, we qualitatively examined how multiple stigmas influence ART engagement among Indian MSM. We conducted 3 focus groups (N = 22) with MSM living with HIV, aged 21-58 years, in Delhi and Hyderabad to identify potential intervention targets and solutions to improve treatment outcomes. Framework analysis and techniques were used to code and analyze translated audio-recordings. Findings revealed enacted stigma, associated with HIV and MSM identity, manifested as familial shame and healthcare discrimination, inhibiting access to support, and decreasing HIV care engagement. Anticipated stigma led to worry about disclosure and societal repercussions. Community-Based-Organizations, ART centers, and family members were primary sources of support, leading to increased ART initiation and retention. Potential solutions included using MSM peer-counselors, increasing social support, and providing HIV education to the general community.
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Affiliation(s)
- Kiran Bhutada
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
| | - Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), C-ShaRP, Chennai, India Chennai, India
| | | | - Jonathan Ross
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
| | | | | | | | - Viraj V. Patel
- Albert Einstein College of Medicine, Montefiore Health System Bronx, NY, USA
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Eubanks A, Coulibaly B, Keita BD, Anoma C, Dah TTE, Mensah E, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L, the CohMSM-PrEP Study Group. Loss to Follow-Up from HIV Pre-Exposure Prophylaxis Care in Men Who Have Sex with Men in West Africa. Viruses 2022; 14:v14112380. [PMID: 36366478 PMCID: PMC9695325 DOI: 10.3390/v14112380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/31/2023] Open
Abstract
Loss to follow-up (LTFU) from HIV pre-exposure prophylaxis (PrEP) care compromises the goal of HIV elimination. We investigated the proportion of LTFU and associated risk factors among men who have sex with men (MSM) enrolled in a PrEP demonstration project in Burkina Faso, Côte d'Ivoire, Mali, and Togo. CohMSM-PrEP, a prospective cohort study, was conducted between November 2017 and June 2021 in community-based clinics. MSM aged 18 years or older at substantial risk of HIV infection received a comprehensive prevention package, including PrEP and peer education. LTFU was defined as not returning to the clinic for six months. Associated risk factors were investigated using a time-varying Cox's model. Of 647 participants followed up for a median time of 15 months, 372 were LTFU (57.5%). LTFU was associated with younger age (adjusted hazard ratio [95% Confidence Interval]; 1.50 [1.17-1.94]), unemployment (1.33 [1.03-1.71]), depression (1.63 [1.12-2.38]), and perceiving no HIV risk with stable male partners (1.61 [1.23-2.10]). Contacting peer educators outside of scheduled visits was protective (0.74 [0.56-0.97]). Our findings show that LTFU from PrEP care in West African MSM is a major challenge to achieving HIV elimination, but that the involvement of peer educators in PrEP delivery helps to limit LTFU by providing users with adequate support.
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Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
- Correspondence: (A.E.); (L.S.-T.)
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou 01 BP 2831, Burkina Faso
- UFR Sciences de la Santé, Université de Ouahigouya, Ouahigouya 01 BP 346, Burkina Faso
| | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence-Alpes-Côte d’Azur, 13005 Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
- Coalition Plus, Community-Based Research Laboratory, 93500 Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, 93500 Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
- Coalition Plus, Community-Based Research Laboratory, 93500 Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, IRD, 34394 Montpellier, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
| | - Christian Laurent
- TransVIHMI, Univ Montpellier, INSERM, IRD, 34394 Montpellier, France
| | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, 13005 Marseille, France
- ARCAD Santé PLUS, Bamako BP E2561, Mali
- Correspondence: (A.E.); (L.S.-T.)
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21
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Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Kaba S, Lokrou KJ, Ouedraogo FR, Badjassim AMF, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa. BMC Public Health 2022; 22:1832. [PMID: 36175860 PMCID: PMC9520809 DOI: 10.1186/s12889-022-14211-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple barriers compromise pre-exposure prophylaxis (PrEP) engagement (i.e., use and adherence) in men who have sex with men (MSM). In low/middle-income countries, little is known about PrEP engagement in this population. In West Africa, the CohMSM-PrEP study was one of the rare interventions providing PrEP to MSM. We estimated PrEP use and correct adherence rates in CohMSM-PrEP, together with associated factors over time. METHODS: CohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included collecting socio-behavioral data, and providing a comprehensive HIV prevention package, PrEP (daily or event-driven), and peer educator (PE)-led counselling. Using repeated measures, multivariate generalized estimating equations models were used to identify factors associated with self-reported i) PrEP use and ii) correct PrEP adherence during participants' most recent anal intercourse (defined as four pills/week for daily users and 2 + 1 + 1 for event-driven users). RESULTS Five hundred twenty participants were included with a median follow-up time of 12 months (IQR 6-21). Of the 2839 intercourses declared over the follow-up period, PrEP use was self-reported for 1996 (70%), and correct PrEP adherence for 1461 (73%) of the latter. PrEP use was higher in participants who also attended participating clinics outside of scheduled visits (adjusted odds ratio (aOR) [95% Confidence Interval, CI], p-value; 1.32[1.01-1.71], 0.040), and in those who practiced condomless anal sex (1.86[1.54-2.24], < 0.001). Correct adherence was higher in those who often contacted PE outside of scheduled visits (2.16[1.01-4.64], 0.047) and in participants who adopted receptive/versatile sexual positions with stable partners (1.36[1.03-1.81], 0.030). Instead, after an interaction effect between financial situation and regimen was tested, it was lower in event-driven users with a difficult/very difficult financial situation (comfortable/just making ends meet & daily, 4.19[2.56-6.86], < 0.001; difficult/very difficult & daily, 6.47[4.05-10.30], < 0.001; comfortable/just making ends meet & event-driven, 1.63[1.22-2.17], 0.001), and in participants who felt alone (0.76[0.58-0.99], 0.042). CONCLUSIONS Community-based clinic attendance and PE contact outside of scheduled visits were both associated with higher PrEP engagement, but some socially and economically marginalized participants struggled with adherence. As scale-up continues in West Africa, we recommend implementing community-based interventions and providing extra support for vulnerable users to ensure adequate PrEP engagement.
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Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ARCAD Santé PLUS, Bamako, Mali
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22
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Nyblade L, Stockton MA, Saalim K, Rabiu Abu‐Ba'are G, Clay S, Chonta M, Dada D, Mankattah E, Vormawor R, Appiah P, Boakye F, Akrong R, Manu A, Gyamerah E, Turner D, Sharma K, Torpey K, Nelson LE. Using a mixed-methods approach to adapt an HIV stigma reduction to address intersectional stigma faced by men who have sex with men in Ghana. J Int AIDS Soc 2022; 25 Suppl 1:e25908. [PMID: 35818873 PMCID: PMC9274363 DOI: 10.1002/jia2.25908] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/22/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In Ghana, men who have sex with men (MSM) are estimated to be 11 times more likely to be living with HIV than the general population. Stigmas at the intersection of HIV, same-sex and gender non-conformity are potential key drivers behind this outsized HIV disease burden. Healthcare workers (HCWs) are essential to HIV prevention, care and treatment and can also be sources of stigma for people living with HIV and MSM. This article describes the process and results of adapting an evidence-based HIV stigma-reduction HCW training curriculum to address HIV, same-sex and gender non-conformity stigma among HCWs in the Greater Accra and Ashanti regions, Ghana. METHODS Six steps were implemented from March 2020 to September 2021: formative research (in-depth interviews with stigma-reduction trainers [n = 8] and MSM living with HIV [n = 10], and focus group discussions with HCWs [n = 8] and MSM [n = 8]); rapid data analysis to inform a first-draft adapted curriculum; a stakeholder adaptation workshop; triangulation of adaptation with HCW baseline survey data (N = 200) and deeper analysis of formative data; iterative discussions with partner organizations for further refinement; external expert review; and final adaptation with the teams of HCWs and MSM being trained to deliver the curriculum. RESULTS Key themes emerging under four immediately actionable drivers of health facility intersectional stigma (awareness, fear, attitudes and facility environment) informed the adaptation of the HIV training curriculum. Based on the findings, existing curriculum exercises were placed in one of four categories: (1) Expand-existing exercises that needed modifications to incorporate deeper MSM and gender non-conformity stigma content; (2) Generate-new exercises to fill gaps; (3) Maintain-exercises to keep with no modifications; and (4) Eliminate-exercises that could be dropped given training time constraints. New exercises were developed to address gender norms, the belief that being MSM is a mental illness and stigmatizing attitudes towards MSM. CONCLUSIONS Getting to the "heart of stigma" requires understanding and responding to both HIV and other intersecting stigma targeting sexual and gender diversity. Findings from this study can inform health facility stigma reduction programming not only for MSM, but also for other populations affected by HIV-related and intersectional stigma in Ghana and beyond.
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Affiliation(s)
- Laura Nyblade
- Global Health DivisionInternational Development GroupRTI InternationalWashingtonDCUSA
| | - Melissa A. Stockton
- Department of PsychiatryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Khalida Saalim
- Global Health DivisionInternational Development GroupRTI InternationalWashingtonDCUSA
| | - Gamji Rabiu Abu‐Ba'are
- Center for Interdisciplinary Research on AIDSSchool of Public HealthYale UniversityNew HavenConnecticutUSA
| | - Sue Clay
- 3C Regional ConsultantsZambiaAfrica
| | | | - Debbie Dada
- School of NursingYale UniversityNew HavenConnecticutUSA
| | | | | | | | | | | | - Adom Manu
- Department of PopulationFamily & Reproductive HealthSchool of Public HealthUniversity of GhanaLegon‐AccraGhana
| | | | - DeAnne Turner
- College of NursingUniversity of South FloridaTampaFloridaUSA
| | - Karan Sharma
- Factor‐Inwentash Faculty of Social WorkUniversity of TorontoTorontoOntarioCanada
| | - Kwasi Torpey
- Department of PopulationFamily & Reproductive HealthSchool of Public HealthUniversity of GhanaLegon‐AccraGhana
| | - LaRon E. Nelson
- 3C Regional ConsultantsZambiaAfrica
- School of NursingYale UniversityNew HavenConnecticutUSA
- Yale Institute for Global HealthSchool of Public HealthNew HavenConnecticutUSA
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23
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Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Rate and Predictors of Ineffective HIV Protection in African Men Who Have Sex with Men Taking Pre-Exposure Prophylaxis. AIDS Behav 2022; 26:3524-3537. [PMID: 35469111 DOI: 10.1007/s10461-022-03692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
We investigated the rate and predictors of ineffective HIV protection in men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) in a prospective cohort study from November 2017 to November 2020 in Mali, Côte d'Ivoire, Burkina Faso, and Togo. MSM had to be 18 years or older and at high risk of HIV infection to participate. They also received a comprehensive sexual health prevention package, including PrEP, in community-based clinics as part of the cohort study. Using socio-behavioral/clinical data, HIV protection during their most recent anal intercourse with a male partner was categorized as effective or ineffective (i.e., incorrect PrEP adherence and no condom use). Seventeen percent (500/2839) of intercourses were ineffectively protected for the 520 study participants. Predictors of ineffective HIV protection included being an event-driven user with financial difficulties, having a high alcohol misuse score, and not being a member of a community association. PrEP programs in West Africa must be tailored to socially vulnerable MSM who struggle to adopt PrEP.
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Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- ARCAD Santé PLUS, Bamako, Mali
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24
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Nardell MF, Adeoti O, Peters C, Kakuhikire B, Govathson-Mandimika C, Long L, Pascoe S, Tsai AC, Katz IT. Men missing from the HIV care continuum in sub-Saharan Africa: a meta-analysis and meta-synthesis. J Int AIDS Soc 2022; 25:e25889. [PMID: 35324089 PMCID: PMC8944222 DOI: 10.1002/jia2.25889] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. METHODS We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. RESULTS AND DISCUSSION We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. CONCLUSIONS Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.
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Affiliation(s)
- Maria F Nardell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Oluwatomi Adeoti
- Department of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Carson Peters
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Bernard Kakuhikire
- Faculty of Business and Management Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Caroline Govathson-Mandimika
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Alexander C Tsai
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ingrid T Katz
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Global Health Institute, Cambridge, Massachusetts, USA
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25
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Ndione AG, Procureur F, Senne JN, Cornaglia F, Gueye K, Ndour CT, Lépine A. Sexuality-Based Stigma and Access to Care: Intersecting Perspectives Between Health Care Providers and Men Who Have Sex With Men in HIV Care Centres in Senegal. Health Policy Plan 2022; 37:587-596. [PMID: 35147679 PMCID: PMC9113117 DOI: 10.1093/heapol/czac010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/18/2022] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Men who have sex with men (MSM) in Senegal face a challenging socio-legal context, marked by homophobia and the illegality of homosexuality. In addition, human immunodeficiency virus (HIV) prevalence among MSM is 27.6%, 46 times greater than the one in the general population (0.5%). Nevertheless, access to healthcare by MSM may be hampered by stigmatizing attitudes from health facility staff (medical and non-medical). This article describes the health facility staff/MSM relationship and analyses its effects on access to healthcare by MSM. The data used were collected through a field survey based on observations and qualitative interviews conducted in 2019 and 2020 with 16 MSM, 1 non-governmental organization (NGO) staff and 9 healthcare providers in Dakar (the capital city) and Mbour (secondary city on the West Coast) hospitals. The data were subject to a thematic analysis assisted by the ATLAS software. The relationship between MSM and healthcare providers is ambiguous. On the one hand, healthcare providers are torn between their professional duty to treat MSM and the cost of being stigmatized by other colleagues. Therefore, they often limit their empathy with MSM within the hospital context. On the other hand, MSM, trusting in the confidentiality of healthcare providers, feel safe in the care pathway. However, we identify the following stigmatizing factors limiting access to care include (1) fear of meeting a relative, (2) difficult relationships with non-medical support staff (mainly security guards), (3) HIV status disclosure and (4) potential conflicts with other MSM. This study is unique as it includes non-medical staff in its respondents. It shows that hospitals are divided into several areas, based on the stigma perceived by MSM. It is important to map out MSM’s care trajectories and spaces and to identify all types of staff working within them, including non-medical staff, and enrol them in stigma reduction interventions.
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Affiliation(s)
| | | | | | | | - Khady Gueye
- Ministry of Health and Social Action of Senegal
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26
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Aidoo-Frimpong G, Orom H, Agbemenu K, Collins RL, Morse GD, Nelson LE. Exploring Awareness, Perceptions, and Willingness to Use HIV Pre-Exposure Prophylaxis: A Qualitative Study of Ghanaian Immigrants in the United States. AIDS Patient Care STDS 2022; 36:8-16. [PMID: 34910883 PMCID: PMC8905245 DOI: 10.1089/apc.2021.0156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV/AIDS disproportionately burdens African immigrants in the United States. Oral pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at high HIV risk, yet uptake is low among racial and ethnic minorities-particularly immigrants. This study explores the awareness, perception, and willingness to use PrEP among Ghanaian immigrants in the United States. WhatsApp, a social media platform, was used to recruit and conduct semi-structured oral interviews with 40 Ghanaian immigrants in March 2020. Interview questions explored awareness of PrEP (whether the participants knew or had knowledge of PrEP before the study), perceptions of PrEP and PrEP users, and willingness to use PrEP. Interviews were audiorecorded, and transcribed. We used NVivo-12 Plus to analyze transcripts for emergent themes. Our sample consisted of Ghanaian adult immigrants (N = 40, 57% male, 71% college educated, age = 32.8 ± 5.7 years, 68% had lived in the United States between 1 and 10 years) residing in 12 US cities. Four major themes emerged: (1) low awareness of PrEP; (2) positive perception of PrEP for HIV prevention; (3) divergent views on PrEP users; and (4) mixed views on willingness to use PrEP. This study presents formative qualitative work, which suggests that Ghanaian immigrants, despite having low awareness of PrEP, may be willing to use PrEP. A key study implication was that stigma reduction interventions might facilitate PrEP scale-up in this population.
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Affiliation(s)
- Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA.,Address correspondence to: Gloria Aidoo-Frimpong, MA, MPH, Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, 3435 Main Street, 321 Kimball Tower, Buffalo, NY 14214-8028, USA
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Kafuli Agbemenu
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - R. Lorraine Collins
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Gene D. Morse
- Pharmacy Practice (Medicine, Pediatrics), University at Buffalo, State University of New York, Buffalo, New York, USA
| | - LaRon E. Nelson
- Yale School of Nursing, MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto—St. Michael's Hospital, Toronto, Canada
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27
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HIV Education, Empathy, and Empowerment (HIVE 3): A Peer Support Intervention for Reducing Intersectional Stigma as a Barrier to HIV Testing among Men Who Have Sex with Men in Ghana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413103. [PMID: 34948712 PMCID: PMC8702001 DOI: 10.3390/ijerph182413103] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022]
Abstract
Men who have sex with men (MSM) in Ghana remain at heightened risk of HIV infection, and face challenges in accessing HIV prevention and care services. Previous research in Ghana shows that MSM face intersectional stigma across ecological levels (family, peers, healthcare settings, and community level) and the criminalization of same-gender sexual behaviors in the country. To protect their wellbeing from exposure to stigma, many MSM avoid interactions with healthcare systems and services, which inadvertently inhibits their opportunities for early detection and treatment of HIV. Consequently, MSM in Ghana carry a disproportionate burden of HIV prevalence (18%) compared to the general population (2%), highlighting the need for culturally relevant processes in HIV/STI prevention, and care communication to optimize sexual health and wellness among MSM in Ghana. To this effect, we collaborated with community partners to use the Assessment, Decision, Adaptation, Production, Topical Experts, Training, Testing (ADAPT-ITT) model to modify a theory-driven smartphone-based peer support intervention to enhance its focus on intersectional stigma reduction, and improve HIV health-seeking behaviors among MSM, including HIV testing and linkage to care. We used the Dennis Peer Support Model to develop the peer support components (emotional, informational, and appraisal support) to increase peer social support, decrease social isolation, and minimize intersectional stigma effects on HIV-related healthcare-seeking behaviors. This paper shows the preliminary acceptability and effectiveness of employing culturally relevant techniques and communication strategies to provide secure peer support to improve HIV prevention and care among key populations in highly stigmatized environments.
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28
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A socio-ecological analysis of factors influencing HIV treatment initiation and adherence among key populations in Papua New Guinea. BMC Public Health 2021; 21:2003. [PMID: 34736447 PMCID: PMC8567601 DOI: 10.1186/s12889-021-12077-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Papua New Guinea (PNG) members of key populations, including female sex workers (FSW), men who have sex with men (MSM) and transgender women (TGW), have higher rates of HIV compared to the general adult population and low engagement in HIV care. This paper examines the socio-ecological factors that encourage or hinder HIV treatment initiation and adherence among HIV positive members of key populations in PNG. METHODS As part of a larger biobehavioural survey of key populations in PNG, 111 semi-structured interviews were conducted with FSW, MSM and TGW, of whom 28 identified as living with HIV. Interviews from 28 HIV positive participants are used in this analysis of the influences that enabled or inhibited HIV treatment initiation and treatment adherence. RESULTS Enablers included awareness of the biomedical benefits of treatment; experiences of the social, familial and health benefits of early treatment initiation and adherence; support provided by family and friends; and non-judgmental and supportive HIV service provision. Factors that inhibited treatment initiation and adherence included perception of good health and denial of HIV diagnosis; poor family support following positive diagnosis; and anonymity and stigma concerns in HIV care services. CONCLUSION Exploring health promotion messages that highlight the positive health impacts of early treatment initiation and adherence; providing client-friendly services and community-based treatment initiation and supply; and rolling out HIV viral load testing across the country could improve health outcomes for these key populations.
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Abubakari GM, Nelson LE, Ogunbajo A, Boakye F, Appiah P, Odhiambo A, Sa T, Zhang N, Ngozi I, Scott A, Maina G, Manu A, Torpey K. Implementation and evaluation of a culturally grounded group-based HIV prevention programme for men who have sex with men in Ghana. Glob Public Health 2021; 16:1028-1045. [PMID: 33050773 PMCID: PMC8728790 DOI: 10.1080/17441692.2020.1832555] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
This study examined the feasibility and acceptability of an evidence-based HIV prevention programme for men who have sex with men (MSM) in Ghana through a participatory approach. The programme involved 57 self-identified adult cisgender MSM and led by a community-based organisation in collaboration with local nurses. We used an explanatory mixed-method design to evaluate the programme. We computed descriptive statistics, relative frequency, and paired proportionate analysis for the survey data and subjected the focus groups data to summative content analysis. Five key themes from the qualitative data indicated strong evidence of the acceptability and efficacy of the programme among MSM. The programme contributed to building social support networks, a sense of social justice among MSM, and facilitated the development of personalised HIV prevention menus by the participants. We observed increases in HIV testing (from 4% to 17%) and increases in the relative frequency of condom use for anal, oral, and vaginal sex. The programme served as an example of a successfully implemented culturally grounded intervention that has the potential to increase HIV and STI awareness and prevention among MSM in Ghana and other highly stigmatised environments.
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Affiliation(s)
- Gamji M’Rabiu Abubakari
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, CT
| | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven CT, USA
- Centre for Interdisciplinary Research on AIDS, Yale University, New Haven CT, USA
- Yale Institute of Global Health, Yale University, New Haven CT, USA
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto ON, Canada
| | | | | | | | - Apondi Odhiambo
- Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada
| | - Ting Sa
- Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Centre, Cincinnati OH, USA
| | - Nanhua Zhang
- Faculty of Health Sciences, York University, Toronto ON, Canada
| | - Ironyah Ngozi
- Faculty of Nursing, University of Saskatchewan, Prince Albert SK, Canada
| | - Adjei Scott
- Faculty of Nursing, University of Saskatchewan, Prince Albert SK, Canada
| | - Geoffrey Maina
- Faculty of Nursing, University of Saskatchewan, Prince Albert SK, Canada
| | - Adom Manu
- School of Public Health, University of Ghana, Legon, Ghana
| | - Kwasi Torpey
- School of Public Health, University of Ghana, Legon, Ghana
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Abubakari GM, Turner D, Ni Z, Conserve DF, Dada D, Otchere A, Amanfoh Y, Boakye F, Torpey K, Nelson LE. Community-Based Interventions as Opportunities to Increase HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men - Lessons From Ghana, West Africa. Front Public Health 2021; 9:660256. [PMID: 34178919 PMCID: PMC8226123 DOI: 10.3389/fpubh.2021.660256] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/23/2021] [Indexed: 12/31/2022] Open
Abstract
MSM in Ghana encounter challenges in accessing HIV services and may experience barriers to HIV self-testing due to multiple forms of stigma present in health care settings. We worked with community-based organization partners to implement three interventions that successfully engaged and retained MSM which provides an opportunity for linkage to self-testing and medical care. These interventions were (1) Many Men Many Voices (3MV) a locally-led culturally grounded group-level HIV prevention program, (2) Auntie's Corner: a mobile-app based connecting MSM to health monitoring by a registered nurse and (3) HIV Education, Empathy, & Empowerment (HIVE3): a mobile-app based peer support intervention for MSM living with HIV. The 3MV intervention may be effective in improving HIV self-testing due to its effectiveness in engaging MSM, increasing HIV testing, and improving MSM understanding of the need for HIV testing. The utilization of apps like Auntie's Corner could positively impact HIV self-testing among MSM because it increases contact with nurses and reporting of symptoms. In HIVE3, participants expressed appreciation of the security and privacy that protects their identities as MSM and the peer mentors' abilities to make referrals to the nurses in Auntie's Corners. The confidentiality component has proven key among MSM and connecting MSM to self-testing through apps to report their process and receive care could increase utilization. Together, we show the efficacy of using the community-engaged process in reaching and engaging highly stigmatized populations like Ghana and sub-Saharan Africa, and its potential in increasing HIV self-testing and linkage to HIV care.
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Affiliation(s)
- Gamji M'Rabiu Abubakari
- Center for Interdisciplinary Research on AIDS, School of Medicine, Yale University, New Haven, CT, United States
| | - DeAnne Turner
- Center for Interdisciplinary Research on AIDS, School of Medicine, Yale University, New Haven, CT, United States
| | - Zhao Ni
- School of Medicine, Yale University, New Haven, CT, United States
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Debbie Dada
- School of Nursing, Yale University, Orange, CA, United States
| | - Amma Otchere
- School of Nursing, Yale University, Orange, CA, United States
| | - Yaw Amanfoh
- School of Social Work at Hunter College, New York, NY, United States
| | | | - Kwasi Torpey
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - LaRon E. Nelson
- School of Nursing, Yale University, Orange, CA, United States
- Yale Institute of Global Health, Yale University, New Haven, CT, United States
- MAP Center for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
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31
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Djiadeu P, Nur J, Mbuagbaw L, Giwa S, Whitfield D, Nelson LE. HIV prevention and treatment interventions for black men who have sex with men in Canada: a protocol for a scoping systematic review. BMJ Open 2021; 11:e043055. [PMID: 33766840 PMCID: PMC7996663 DOI: 10.1136/bmjopen-2020-043055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/13/2020] [Accepted: 02/19/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Globally, rates of HIV are disproportionately high among black men who have sex with men (MSM). In Canada, race, gender and sexuality have been investigated as separate factors that influence quality of care within and progression along the HIV care continuum. Traditional compartmental approaches to synthesising the HIV care continuum literature do not sufficiently account for intersectional experiences and marginalisation of Black MSM (BMSM). Moreover, there is limited research outlining access to and quality of care as specific barriers to progression along the care continuum among BMSM in Canada. OBJECTIVES The primary objective of this scoping review is to assess the state of the science regarding the influence of access to and quality of HIV care continuum outcomes for BMSM in Canada. METHODS AND ANALYSIS We will conduct a systematic search of published literature of quantitative and qualitative studies published on Canadian BMSM's healthcare and HIV status. The searches will be conducted through MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, the NHUS Economic Development Database, Global Health, APA PsychInfo, PubMed and Web of Science. ELIGIBILITY CRITERIA Eligible studies will include data on black MSM living with or without HIV in Canada and must be published after 1983 in either English or French. Screening and data extraction will be conducted in duplicate. Any discrepancies that arise will be resolved by consulting a third author. The findings will subsequently be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. ETHICS AND DISSEMINATION Ethics approval is not required as secondary published data will be used. Our findings will be disseminated as peer-reviewed manuscripts, at conferences, student rounds and could be of interest to government health agencies and HIV/AIDS service organisations.
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Affiliation(s)
- Pascal Djiadeu
- Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jemal Nur
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Lawrence Mbuagbaw
- Health Research Methods, Evidence and Impact, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sulaimon Giwa
- School of Social Work, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Darren Whitfield
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laron E Nelson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
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Kumi-Kyereme A. Sexual and reproductive health services utilisation amongst in-school young people with disabilities in Ghana. Afr J Disabil 2021; 10:671. [PMID: 33824858 PMCID: PMC8007993 DOI: 10.4102/ajod.v10i0.671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/07/2021] [Indexed: 11/02/2022] Open
Abstract
Background Sexual and reproductive health (SRH) of young people including those with disabilities is a major public health concern globally. However, available evidence on their use of sexual and reproductive health services (SRHS) is inconsistent. Objective This study investigated utilisation of SRHS amongst the in-school young people with disabilities (YPWDs) in Ghana using the healthcare utilisation model. Methods Guided by the cross-sectional study design, a questionnaire was used to obtain data from 2114 blind and deaf pupils or students in the age group 10-24 years, sampled from 15 purposively selected special schools for the deaf and the blind in Ghana. Results About seven out of every 10 respondents had ever utilised SRHS. The proportion was higher amongst the males (67.8%) compared with the females (62.8%). Young persons with disabilities in the coastal (OR = 0.03, 95% CI = 0.01-0.22) and middle (OR = 0.06, 95% CI = 0.01-0.44) zones were less likely to have ever utilised SRHS compared with those in the northern ecological zone. The blind pupils or students were more likely to have ever utilised SRHS than the deaf (OR = 1.45, 95% CI = 1.26-3.11). Conclusions Generally, SRHS utilisation amongst the in-school YPWDs in Ghana is high but significantly associated with some predisposing, need and enabling or disabling factors. This underscores the need for policymakers to consider in-school YPWDs as a heterogeneous group in the design and implementation of SRHS programmes. The Ghana Education Service in collaboration with the Ghana Health Service should adopt appropriate pragmatic measures and targeted interventions in the special schools to address the SRH needs of the pupils or students.
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Affiliation(s)
- Akwasi Kumi-Kyereme
- Department of Population and Health, Faculty of Social Sciences, University of Cape Coast, Cape Coast, Ghana
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Gu LY, Zhang N, Mayer KH, McMahon JM, Nam S, Conserve DF, Moskow M, Brasch J, Adu-Sarkodie Y, Agyarko-Poku T, Boakye F, Nelson LE. Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa. J Int Assoc Provid AIDS Care 2021; 20:2325958220978113. [PMID: 33733909 PMCID: PMC7983411 DOI: 10.1177/2325958220978113] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM (N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate (OR = 1.63, p < .01), vicarious HIV stigma (OR = 2.73, p < .01), and age (OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC (OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.
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Affiliation(s)
- Lily Y. Gu
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nanhua Zhang
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Soohyun Nam
- School of Nursing, Yale University, New Haven, CT, USA
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Marian Moskow
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Judith Brasch
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Yaw Adu-Sarkodie
- School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Thomas Agyarko-Poku
- School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | | | - LaRon E. Nelson
- School of Nursing, Yale University, New Haven, CT, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Yale Institute of Global Health, Yale University, New Haven, CT, USA
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
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Lazuardi E, Newman CE, Anintya I, Rowe E, Wirawan DN, Wisaksana R, Subronto YW, Kusmayanti NA, Iskandar S, Kaldor J, Bell S. Increasing HIV treatment access, uptake and use among men who have sex with men in urban Indonesia: evidence from a qualitative study in three cities. Health Policy Plan 2020; 35:16-25. [PMID: 31625559 DOI: 10.1093/heapol/czz128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2019] [Indexed: 11/12/2022] Open
Abstract
Men who have sex with men make up one of four key populations identified as critical to a successful HIV response in Indonesia. Despite international policies supporting HIV treatment in low- and middle-income countries, Indonesia is one of the few countries experiencing low coverage of HIV treatment and little decrease in HIV incidence. There is poor retention in care and low viral suppression rates among key populations such as men who have sex with men. The national government has committed to increasing treatment access and uptake for people with HIV but little is known about how these men themselves view, use and experience these medications. Drawing on qualitative data collected in 2015-16 from 24 HIV-positive men who have sex with men living in three Indonesian cities, we observed multiple intersecting social and contextual factors that can influence effective HIV treatment use. Although shared stories of strong side effects and fear of unwanted disclosure inhibited treatment uptake, social support from 'buddies' helped to navigate healthcare systems and sharing medication among peers enabled adherence. In order to improve treatment uptake and adherence among Indonesian men who have sex with men living with HIV, these divergent effects of the social meanings and practices associated with HIV treatments in Indonesia must be better acknowledged. A more comprehensive understanding of social and community practices within key populations can strengthen national efforts to improve treatment access and increase adherence. Ongoing decentralization of healthcare in Indonesia, and differentiated care models that enable initiation of treatment in community settings and involve non-medical, community-based organizations in the provision of treatment services have the potential to address the needs of individuals who fall into a key population category such as men who have sex with men.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.,Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Jl. Raya Sesetan No. 270, Kota Denpasar, Bali 80223, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Jl. Raya Sesetan No. 270, Kota Denpasar, Bali 80223, Indonesia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Jl. P.B. Sudirman, Kota Denpasar, Bali 80232, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia.,Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Jl. Pasteur No. 38, Kota Bandung, West Java 40161, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Farmako, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Nur Aini Kusmayanti
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl. Medika, Kabupaten Sleman, Daerah Istimewa Yogyakarta 55281, Indonesia
| | - Shelly Iskandar
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Jl. Eijkman No. 38, Kota Bandung, West Java 40161, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia.,Centre for Social Research in Health, UNSW Sydney, Sydney, NSW 2052, Australia
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Crowell TA, Fast PE, Bekker LG, Sanders EJ. Involvement of African men and transgender women who have sex with men in HIV research: progress, but much more must be done. J Int AIDS Soc 2020; 23 Suppl 6:e25596. [PMID: 33000908 PMCID: PMC7527757 DOI: 10.1002/jia2.25596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Patricia E Fast
- International AIDS Vaccine Initiative, New York, NY, USA
- School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Eduard J Sanders
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Oxford University, Oxford, United Kingdom
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Abstract
PURPOSE OF REVIEW HIV prevention and treatment interventions for MSM are not well studied or reported from low-income and middle-income countries (LMIC) in comparison to those targeting gender-conforming populations. Some evidence-based strategies to engage MSM in appropriate healthcare have recently reported on their experiences and impact. Novel recruitment strategies have been developed for treatment and preexposure prophylaxis (PrEP) for MSM, leveraging new community engagement strategies and social media technologies. RECENT FINDINGS Despite publication of several new guidelines, there is little recent evidence available to guide MSM health programs in LMIC, highlighting the need for ongoing research and publication. Some important PrEP pilot study results have recently been published, such as the PrEP Brazil and Princess PrEP programmes, which could guide the scale-up of MSM PrEP. The novel use of technology and online platforms to strengthen MSM health delivery and support is particularly important. SUMMARY Providing healthcare to MSM requires consideration of context, broad stakeholder engagement, implementation of best practice guidelines and ongoing situational assessment and integration of novel community engagement methods that are evidence-based. Implementation of improved antiretroviral programmes and the access to PrEP for MSM are vital.
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Gyamerah AO, Taylor KD, Atuahene K, Anarfi JK, Fletcher M, Raymond HF, McFarland W, Dodoo FNA. Stigma, discrimination, violence, and HIV testing among men who have sex with men in four major cities in Ghana. AIDS Care 2020; 32:1036-1044. [PMID: 32362131 DOI: 10.1080/09540121.2020.1757020] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
LGBTQ populations experience human rights abuses worldwide; data need to document the health impact of these experiences in Africa. In Ghana, we measured events of sexuality-based stigma, discrimination, and violence among men who have sex with men (MSM) and the impact on HIV testing behavior. Data are from respondent-driven sampling surveillance surveys in Accra/Tema, Kumasi, Cape Coast/Takoradi, and Koforidua. Discrimination was common among MSM: 6.2%-30.6% were refused services, 29.0%-48.9% experienced verbal/symbolic violence, 2.8%-12.8% experienced physical violence, 12.3%-30.0% experienced sexual violence due to their sexuality in the preceding year. MSM who experienced sexual violence in their first male sexual encounter were less likely to ever test for HIV in Accra/Tema and Cape Coast/Takoradi. Further studies are needed to examine the impact of stigma and violence on MSM's HIV health-seeking behavior in Ghana. Structural interventions are needed to mitigate the consequences of stigma and discrimination on MSM health and well-being.
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Affiliation(s)
- Akua O Gyamerah
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Kelly D Taylor
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - John K Anarfi
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
| | | | - Henry F Raymond
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - F Nii-Amoo Dodoo
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana.,The Pennsylvania State University, University Park, PA, USA
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Parker W, Schubert J, Owusu-Ansah S, Asante-Afari K, Edem Assisi S, Adiku ED, Pennas T, Evans Williams S. Addressing community-level stigma toward key populations: communication insights from action research in Ghana. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:109-116. [PMID: 32320333 DOI: 10.2989/16085906.2020.1743727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Global HIV response emphasises improving the uptake of HIV testing, providing access to antiretroviral therapy and sustaining viral suppression with a view to curtailing the pandemic by 2030. Stigma and discrimination impede this response by limiting engagement with the HIV continuum among sub-populations such as men who have sex with men (MSM) and female sex workers (FSW). Stigma reduction strategies that explore community-level solutions and barriers to care for these key populations are under-explored. Methods: A formative action research study was conducted in two regions of Ghana to understand community perceptions towards MSM and FSW to identify potential stigma reduction concepts. Multi-day interactive enquiries explored factors underlying stigma including rationale, personal values, perspectives on attitudinal change and related communication. Results: Rationale for stigmatisation of MSM and FSW by participants highlight religious and cultural concerns. Perceived behaviours and practices of MSM and FSW were said to undermine religious, moral and community values. Attitudes of participants towards MSM and FSW became more accepting through critical discussion that revealed contradictions within the stigma construct and discomfort with the effects of stigma. Conclusions: Participants realised that causing hurt or harm to others through stigma was not consistent with their religious and cultural values, nor how they saw themselves as people. There were four entry points that undermined the rationale for stigma: The need to know and understand 'the other', the need to be true to one's moral values, the need for empathy towards others, and recognition of the value of all people within a communal whole. These findings are relevant for engaging communities in stigma-reduction programs and improving health-seeking and adherence to care among key populations in similar African settings.
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Affiliation(s)
- Warren Parker
- Independent public health and communication consultant, San Diego, USA
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Nijhawan AE, Higashi RT, Marks EG, Tiruneh YM, Lee SC. Patient and Provider Perspectives on 30-Day Readmissions, Preventability, and Strategies for Improving Transitions of Care for Patients with HIV at a Safety Net Hospital. J Int Assoc Provid AIDS Care 2020; 18:2325958219827615. [PMID: 30760091 PMCID: PMC6748499 DOI: 10.1177/2325958219827615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Thirty-day hospital readmissions, a key quality metric, are common among people living with HIV. We assessed perceived causes of 30-day readmissions, factors associated with preventability, and strategies to reduce preventable readmissions and improve continuity of care for HIV-positive individuals. Patient, provider, and staff perspectives toward 30-day readmissions were evaluated in semistructured interviews (n = 86) conducted in triads (HIV-positive patient, medical provider, and case manager) recruited from an inpatient safety net hospital. Iterative analysis included both deductive and inductive themes. Key findings include the following: (1) The 30-day metric should be adjusted for safety net institutions and patients with AIDS; (2) Participants disagreed about preventability, especially regarding patient-level factors; (3) Various stakeholders proposed readmission reduction strategies that spanned the inpatient to outpatient care continuum. Based on these diverse perspectives, we outline multiple interventions, from teach-back patient education to postdischarge home visits, which could substantially decrease hospital readmissions in this underserved population.
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Affiliation(s)
- Ank E Nijhawan
- 1 Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.,2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,3 Parkland Health & Hospital System, Dallas, TX, USA
| | - Robin T Higashi
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Emily G Marks
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yordanos M Tiruneh
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,4 Department of Community Health, University of Texas Health Science Center, Tyler, TX, USA
| | - Simon Craddock Lee
- 2 Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
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40
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Coulaud PJ, Sagaon-Teyssier L, Mimi M, M'madi Mrenda B, Maradan G, Mora M, Bourrelly M, Keita BD, Keita AA, Anoma C, Babo Yoro SA, Dah TTE, Coulibaly C, Mensah E, Agbomadji S, Bernier A, Couderc C, Laurent C, Spire B. Combined Sexual Behavioral Profiles in HIV-Seronegative Men Who have Sex with Men in West Africa (CohMSM ANRS 12324-Expertise France). ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:331-345. [PMID: 31399923 DOI: 10.1007/s10508-019-01513-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 06/10/2019] [Accepted: 07/10/2019] [Indexed: 06/10/2023]
Abstract
Understanding the dynamics of HIV infection in men who have sex with men (MSM) can help improve efficiency in existing prevention strategies. We aimed to identify and describe the sexual behaviors of MSM most at risk of HIV infection in West Africa. HIV-negative MSM were provided a quarterly preventive follow-up package in the community-based cohort CohMSM. They completed face-to-face sociobehavioral questionnaires every 6 months. This sub-study on 520 participants used a baseline, 6-, 12- and 18-month data cluster analysis to categorize two profiles (high risk [HRE] and moderate risk [MRE] of exposure to HIV) based on three risky sexual practices over the previous 6 months. HRE-MSM (61%) were more engaged in receptive practices, had a higher proportion of inconsistent condom use during anal sex, and reported more sexual partners than MRE-MSM (39%). The proportion of HIV seroconversions observed during the first 18 months of follow-up using sexual behavioral profiles (92% are HRE-MSM) was higher than using the three risky sexual practices separately. Factors associated with the HRE-MSM profile were being younger (18-21 years), reporting stigma, and having had no female partner while being attracted only to men. Our findings suggest that in order to identify MSM most at risk of HIV infection, several risky sexual practices need to be evaluated in a combined approach. Prevention programs should pay particular attention to younger MSM, and implement activities addressing questions of MSM identity and stigma in order to reduce the dynamic of HIV infection in Western African MSM.
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Affiliation(s)
- Pierre-Julien Coulaud
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France.
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
| | - Luis Sagaon-Teyssier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Mohamed Mimi
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Bakridine M'madi Mrenda
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Gwenaëlle Maradan
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Marion Mora
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | | | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | | | - Bruno Spire
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Faculté de Médecine Timone, Aix Marseille Univ, 27 Boulevard Jean Moulin, 13385, Marseille Cedex 05, France
- ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
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Mitchell E, Lazuardi E, Rowe E, Anintya I, Wirawan DN, Wisaksana R, Subronto YW, Prameswari HD, Kaldor J, Bell S. Barriers and Enablers to HIV Care Among Waria (Transgender Women) in Indonesia: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:538-552. [PMID: 31815531 DOI: 10.1521/aeap.2019.31.6.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Transgender women (waria) in Indonesia have high rates of HIV and experience barriers accessing HIV services. This qualitative research explored barriers and facilitators to HIV care among waria in Indonesia. Between 2015 and 2016, 42 participants were involved in focus group discussions and in-depth interviews across three urban sites in Indonesia to examine participants' experiences and views on HIV prevention, testing, treatment initiation, and treatment adherence. Data were analyzed thematically. Barriers to accessing HIV care services included perceptions of health and HIV treatment, confidentiality and stigma concerns, and poor access to health insurance. Facilitators to HIV care included recognition of health and perceived susceptibility, perceptions of treatment benefits and consequences of non-adherence, access to social support, and patient-friendly services. Research findings highlight the importance of improving HIV treatment literacy, safeguarding community responses to addressing HIV vulnerability, addressing confidentiality and stigma issues, ensuring services are transgender-friendly, and increasing health insurance coverage.
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Affiliation(s)
| | - Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Emily Rowe
- Kerti Praja Foundation, Denpasar, Indonesia
| | - Irma Anintya
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Dewa N Wirawan
- Kerti Praja Foundation, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Disease Research Center, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hellen Dewi Prameswari
- HIV AIDS and STI Subdirectorate, Directorate of Communicable Disease Prevention and Control, Directorate General of Disease Prevention and Control, Ministry of Health of Indonesia, Jakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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42
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Stannah J, Dale E, Elmes J, Staunton R, Beyrer C, Mitchell KM, Boily MC. HIV testing and engagement with the HIV treatment cascade among men who have sex with men in Africa: a systematic review and meta-analysis. Lancet HIV 2019; 6:e769-e787. [PMID: 31601542 PMCID: PMC6993044 DOI: 10.1016/s2352-3018(19)30239-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND HIV disproportionately affects gay, bisexual, and other men who have sex with men (MSM) in Africa, where many countries criminalise same-sex behaviour. We assessed changes in the engagement of African MSM with HIV testing and treatment cascade stages over time, and the effect of anti-LGBT legislation and stigma. METHODS We systematically searched Embase, Global Health, MEDLINE, Scopus, and Web of Science for peer-reviewed cross-sectional or longitudinal studies recruiting at least ten MSM, published from Jan 1, 1980, to Oct 10, 2018. We extracted or derived estimates of HIV testing, engagement with the HIV treatment cascade, or both among African MSM from published reports. We derived pooled estimates using inverse-variance random-effects models. We used subgroup and meta-regression analysis to assess associations between testing and status awareness outcomes and study and participant characteristics, including the severity of country-level anti-LGBT legislation. FINDINGS Our searches identified 75 independent eligible studies that provided estimates for 44 993 MSM across one or more of five testing and treatment cascade outcomes. HIV testing increased significantly over time overall, with pooled proportions of MSM ever tested for HIV of 67·3% (95% CI 62·1-72·3; 44 estimates) and tested in the past 12 months of 50·1% (42·4-57·8, 31 estimates) after 2011, which were 14·8 percentage points and 17·9 percentage points higher than before 2011, respectively. After 2011, ever testing was highest in southern Africa (80·0%), and lowest in northern Africa (34·4%), with the greatest increase in western Africa (from 42·4% to 70·9%). Levels of testing ever, in the past 12 months, and status awareness were statistically significantly lower in countries with the most severe anti-LGBT legislation compared with countries with the least severe legislation (57·4% vs 71·6%, p=0·0056; 35·5% vs 49·3%, p=0·010; 6·7% vs 22·0%, p=0·0050). Few estimates were available for later stages of the treatment cascade. Available data after 2011 suggest that the pooled proportion of MSM HIV-positive aware has remained low (18·5%, 12·5-25·3; 28 estimates), whereas proportions of current antiretroviral therapy (ART) use were 23·7% (15·5-33·0; 13 estimates) among all MSM living with HIV and 60·1% (48·6-71·1; five estimates) among MSM HIV-positive aware of their status. Pooled levels of viral suppression among MSM currently on ART were 75·6% (64·4-85·5; four estimates), but only 24·7% (18·8-31·2; four estimates) among all MSM living with HIV. INTERPRETATION Despite improvements in HIV testing among MSM in Africa, HIV status awareness, ART coverage, and viral suppression remain much lower than required to achieve UNAIDS 90-90-90 targets. Further studies are urgently needed to provide more accurate estimates of levels of status awareness, engagement in care, ART coverage, and viral suppression among MSM to inform prevention efforts aimed at improving access to HIV services for MSM. Severe anti-LGBT legislation might be associated with lower HIV testing and status awareness; therefore, further research is needed to assess the effect of such legislation on HIV testing and engagement with the HIV treatment cascade among MSM. FUNDING US National Institutes of Health, UK Medical Research Council.
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Affiliation(s)
- James Stannah
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Elizabeth Dale
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Roisin Staunton
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Kate M Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK.
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43
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Ogunbajo A, Leblanc NM, Kushwaha S, Boakye F, Hanson S, Smith MDR, Nelson LE. Knowledge and Acceptability of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in Ghana. AIDS Care 2019; 32:330-336. [PMID: 31597455 DOI: 10.1080/09540121.2019.1675858] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In Ghana, men who have sex with men (MSM) are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a biomedical intervention that reduces the risk of HIV infection but is not currently available in Ghana. This paper explores knowledge and acceptability of HIV PrEP among Ghanaian MSM. Qualitative content analysis was conducted on 22 focus group discussions (N = 137) conducted between March and June 2012 in Accra, Kumasi, and Manya Krobo. Overall, participants reported low knowledge of PrEP. However, once information about PrEP was provided, there was high acceptability. The primary reason for acceptability was that PrEP provided an extra level of protection against HIV. Acceptability of PrEP was conditioned on it having minimal side effects, being affordable and efficient in preventing HIV infection. No acceptability of PrEP was attributed to limited knowledge of side effects and perceived lack of effectiveness. The reasons provided to utilize PrEP and condoms were that condoms protect against other STIs, and sexual partner factors. This is the first known study to explore PrEP knowledge and acceptability among Ghanaian MSM. It is important that key stakeholders preemptively address potential barriers to PrEP acceptability, uptake, and adherence, especially among MSM, once PrEP becomes available in Ghana.
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Affiliation(s)
- Adedotun Ogunbajo
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA
| | | | - Sameer Kushwaha
- University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | | | - Samuel Hanson
- Centre for Popular Education and Human Rights, Accra, Ghana
| | | | - LaRon E Nelson
- University of Rochester, School of Nursing, Rochester, NY, USA.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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44
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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 2019; 16:320-331. [PMID: 31213225 DOI: 10.1071/sh18191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [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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45
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Lazuardi E, Newman CE, Tasya IA, Rowe E, Wirawan DN, Wisaksana R, Subronto YW, Kaldor J, Kusmayanti NA, Iskandar S, Bell S. Understanding the Social Influences on Engaging Key Populations With HIV Prevention: A Qualitative Study With Men Who Have Sex With Men in Three Indonesian Cities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:206-223. [PMID: 31145004 DOI: 10.1521/aeap.2019.31.3.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The globally recognized test and treat approach underpins Indonesian national strategies to reduce and prevent HIV among key populations, including men who have sex with men. More comprehensive understanding of how engagement with HIV prevention is shaped by social and community practices will support these efforts. Between 2015 and 2016, focus groups and semi-structured interviews were conducted with 54 men who have sex with men in three urban settings in Indonesia to elicit their views on, and experiences of, HIV prevention and care. Focused on data relating to testing, findings documented the important influence of informal peer networks, community-based organizations and outreach workers. Some social dimensions of service access complicated this, particularly fear of stigma or lack of confidentiality in large service settings. The many differences between men challenges assumptions that a single set of HIV prevention strategies will work to engage all men who have sex with men living in Indonesia.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Irma Anintya Tasya
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Emily Rowe
- Yayasan Kerti Praja, Denpasar, Indonesia
| | - D N Wirawan
- Yayasan Kerti Praja, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Nur Aini Kusmayanti
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Shelly Iskandar
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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46
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Coulaud PJ, Préau M, Maradan G, Mora M, Traoré F, Oga M, Thio E, Ekon L, Dembele Keita B, Anoma C, Ter Tiero Dah E, Mensah E, Bernier A, Couderc C, Laurent C, Spire B. Taking empowerment into account: the response of community-based organisations to the HIV care needs of men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France). AIDS Care 2019; 31:1403-1411. [PMID: 30829534 DOI: 10.1080/09540121.2019.1587358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Empowerment is an ongoing process through which individuals and communities appropriate power and acquire the capability to function autonomously. Research on empowerment in men who have sex with men (MSM) is lacking in community-based contexts. We investigated the relationship between willingness to be empowered and HIV care needs in West African MSM accessing community-based organisations' (CBO) services. Fifty-three interviews were administered to HIV-negative MSM participating in the CohMSM study (Mali, Burkina Faso, Côte d'Ivoire, Togo). Five indicators of empowerment were identified from a discourse analysis: (i) motivation to access HIV services, (ii) willingness to improve HIV services, (iii) desire to be involved in new activities, (iv) desire to participate in such services, (v) willingness to collaborate in decision making. Based on these indicators, participants were classified into two profiles: high (19/53, 36%) and low (34/53, 64%) level of willingness to be empowered (HWE, LWE). Using a thematic analysis, HWE participants were focused on collective benefit (preventive follow-up, questions about MSM identity), while LWE participants were centred on individual benefit (medical care). CBOs should consider empowerment as a tool to advance collective health benefits for MSM. To improve empowerment in MSM, specific training on issues regarding sexual identity and stigma is needed for CBO providers.
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Affiliation(s)
- Pierre-Julien Coulaud
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Marie Préau
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France.,GRePS Lyon 2 Université, Université de Lyon , Bron , France
| | - Gwenaelle Maradan
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Marion Mora
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
| | | | - Maxime Oga
- Programme PAC-CI Site ANRS , Abidjan , Côte d'Ivoire
| | - Elisabeth Thio
- Association African Solidarité , Ouagadougou , Burkina Faso
| | | | | | | | - Elias Ter Tiero Dah
- Association African Solidarité , Ouagadougou , Burkina Faso.,Centre Muraz , Bobo-Dioulasso , Burkina Faso
| | | | | | - Clotilde Couderc
- IRD, INSERM, Univ Montpellier, TransVIHMI , Montpellier , France
| | | | - Bruno Spire
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
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47
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Shangani S, Naanyu V, Operario D, Genberg B. Stigma and Healthcare-Seeking Practices of Men Who Have Sex with Men in Western Kenya: A Mixed-Methods Approach for Scale Validation. AIDS Patient Care STDS 2018; 32:477-486. [PMID: 30398953 DOI: 10.1089/apc.2018.0101] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In sub-Saharan Africa, men who have sex with men (MSM) experience high HIV prevalence, in part, due to stigma and discrimination creating barriers to engagement in prevention and care services. We examined the reliability and validity of measures of stigma and satisfaction with healthcare providers, as well as explored whether scores on the factors varied across sociodemographic variables among MSM in western Kenya. A mixed-methods design using a sequential triangulation approach was adopted, involving a survey of 89 MSM and 10 key informant interviews. Reliability and correlation analyses, exploratory factor analyses, t-tests, and ANOVAs (analyses of variances) were conducted to test the scale's psychometric properties and examine differences in mean scores by demographics. Thematic analysis with qualitative data was used to validate the meaning of scales and explore how stigma influences and relates to satisfaction with healthcare providers. Of 89 participants, 50% identified as homosexual, 52% had college degree, 45% were above 25 years, and 72% had ever been married. Three subscales measuring enacted stigma, internalized stigma, and mistrust of healthcare providers showed good reliability (α = 0.80, α = 0.90, and α = 0.90). Men who identified as homosexual reported higher mean scores of enacted stigma and distrust of healthcare providers compared to heterosexual/bisexual identified (p < 0.001). Qualitative data revealed perceptions that healthcare providers were not knowledgeable to handle MSM needs. Study provides preliminary evidence for the reliability and validity of measures of stigma and mistrust of healthcare providers in Kenya. Quantitative and qualitative findings highlight the need for interventions to reduce stigma and create a more inclusive health system.
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Affiliation(s)
- Sylvia Shangani
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Violet Naanyu
- Department of Behavioral Social Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Don Operario
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Becky Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island
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48
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Ramadhani HO, Ndembi N, Nowak RG, Ononaku U, Gwamna J, Orazulike I, Adebajo S, Crowell TA, Liu H, Baral SD, Ake J, Charurat ME. Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services. J Acquir Immune Defic Syndr 2018; 79:e7-e16. [PMID: 29781881 PMCID: PMC6092228 DOI: 10.1097/qai.0000000000001756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND SETTING Because data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited settings are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria. METHODS TRUST/RV368 study used respondent-driven sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every 3 months (Abuja) or 6 months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and 6-month viral suppression. RESULTS A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed 6 months, and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were each positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at 6 months. CONCLUSIONS Social determinants of health potentiated increased HIV care continuum outcomes. Integration of HIV prevention, HIV counseling and testing services, and universal coverage of ART into a community-based clinic is critical in achieving better HIV care continuum outcomes.
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Affiliation(s)
- Habib O Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Nicaise Ndembi
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Rebecca G Nowak
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
| | - Uchenna Ononaku
- Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Jerry Gwamna
- U.S. Centers for Disease Control and Prevention, Abuja, Federal Capital Territory, Nigeria
| | - Ifeanyi Orazulike
- International Center for Advocacy and Rights to Health, Abuja, Federal Capital Territory, Nigeria
| | - Sylvia Adebajo
- Population Council, Abuja, Federal Capital Territory, Nigeria
| | - Trevor A Crowell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Hongjie Liu
- University of Maryland School of Public Health, College Park, MD
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Julie Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD
| | - Man E Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
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