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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [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. Res Sq 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mlunde LB, Saalim K, Mbwambo JK, Kiwia P, Fitch E, Manyama W, Rugemalila I, Clay S, Lambdin BH, Stelmach RD, Bann C, Nyblade L. Adapting a health facility HIV stigma-reduction participatory training intervention to address drug use stigma in HIV care and treatment clinics in Dar es Salaam, Tanzania. Harm Reduct J 2024; 21:65. [PMID: 38491349 PMCID: PMC10941424 DOI: 10.1186/s12954-024-00965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND HIV prevalence among people who use drugs (PWUD) in Tanzania is 4-7 times higher than in the general population, underscoring an urgent need to increase HIV testing and treatment among PWUD. Drug use stigma within HIV clinics is a barrier to HIV treatment for PWUD, yet few interventions to address HIV-clinic drug use stigma exist. Guided by the ADAPT-ITT model, we adapted the participatory training curriculum of the evidence-based Health Policy Plus Total Facility Approach to HIV stigma reduction, to address drug use stigma in HIV care and treatment clinics (CTCs). METHODS The first step in the training curriculum adaptation process was formative research. We conducted 32 in-depth interviews in Dar es Salaam, Tanzania: 18 (11 men and 7 women) with PWUD living with HIV, and 14 with a mix of clinical [7] and non-clinical [7] CTC staff (5 men and 9 women). Data were analyzed through rapid qualitative analysis to inform initial curriculum adaptation. This initial draft curriculum was then further adapted and refined through multiple iterative steps of review, feedback and revision including a 2-day stakeholder workshop and external expert review. RESULTS Four CTC drug use stigma drivers emerged as key to address in the curriculum adaptation: (1) Lack of awareness of the manifestations and consequences of drug use stigma in CTCs (e.g., name calling, ignoring PWUD and denial of care); (2) Negative stereotypes (e.g., all PWUD are thieves, dangerous); (3) Fear of providing services to PWUD, and; (4) Lack of knowledge about drug use as a medical condition and absence of skills to care for PWUD. Five, 2.5-hour participatory training sessions were developed with topics focused on creating awareness of stigma and its consequences, understanding and addressing stereotypes and fears of interacting with PWUD; understanding drug use, addiction, and co-occurring conditions; deepening understanding of drug use stigma and creating empathy, including a panel session with people who had used drugs; and working to create actionable change. CONCLUSION Understanding context specific drivers and manifestations of drug use stigma from the perspective of PWUD and health workers allowed for ready adaptation of an existing evidence-based HIV-stigma reduction intervention to address drug use stigma in HIV care and treatment clinics. Future steps include a pilot test of the adapted intervention.
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Affiliation(s)
- Linda B Mlunde
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | | | - Jessie K Mbwambo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Pfiriael Kiwia
- Kimara Peer Educators and Health Promoters, Dar es Salaam, Tanzania
| | | | | | | | - Sue Clay
- 3C Regional Consultants, Lusaka, Zambia
| | | | | | - Carla Bann
- RTI International, Research Triangle Park, NC, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abu-Ba'are GR, Aidoo-Frimpong G, Stockton M, Zigah EY, Amuah S, Amu-Adu P, Amoh-Otoo RP, Nyblade L, Torpey K, Nelson LE. "I told myself, be bold and go and test": Motivators and barriers to HIV testing among gay, bisexual, and other cis-gender men who have sex with men in Ghana ‒ West Africa. PLOS Glob Public Health 2024; 4:e0002231. [PMID: 38206889 PMCID: PMC10783711 DOI: 10.1371/journal.pgph.0002231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024]
Abstract
Despite a disproportionately high burden of HIV, GBMSM in Ghana and sub-Saharan Africa often delay testing until the point of illness. However, limited studies examine factors that affect their participation in testing. We used qualitative in-depth interviews (IDIs) and focus group discussions (FGDs) to collect insights into experiences, motivators, and barriers to HIV testing among GBMSM. Two community-based organizations used snowball and convenience sampling to recruit 10 GBMSM for IDIs and 8 to 12 for FGDs. We transcribed, coded, identified, and analyzed the relationship and commonalities between the participants' responses. Under experiences with testing, 1) fear of HIV infection created a stressful HIV testing experience, and 2) a friendly and supportive healthcare environment facilitated a positive experience in healthcare facilities. Motivators or facilitators of testing include 1) the perception or belief that HIV testing is an HIV prevention strategy; 2) encouragement from friends and peers; 3) understanding risk associated with certain sexual behaviors; 4) education or information on HIV; 5) access to free testing and incentives; 6) early symptoms and provider recommendation. Barriers to HIV testing include 1) negative community perceptions of HIV; 2) individual-level low-risk perception or indifference about HIV infection; 3) health system issues; 5) Perceived stigma at healthcare facilities. The findings point to the need to address critical issues around stigma, education, peer support, and healthcare resources through interventions and research to improve HIV testing among GBMSM in the country.
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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, Rochester, New York, United States of America
- Department of Public Health Sciences, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
- Behavioral, Sexual and Global Health Lab, West Africa Site, Jama'a Action, West Legon, Accra, Ghana
| | - Gloria Aidoo-Frimpong
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Melissa Stockton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual and Global Health Lab, West Africa Site, Jama'a Action, West Legon, Accra, Ghana
- Priorities on Rights and Sexual Health, Accra, Ghana
| | - Samuel Amuah
- Youth Alliance for Health and Human Rights, Kumasi, Ghana
| | | | | | - Laura Nyblade
- RTI International, Washington, District of Columbia, United States of America
| | - Kwasi Torpey
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - LaRon E Nelson
- Yale AIDS Prevention Program (Y-APT), Center for Interdisciplinary Research on AIDS, School of Public Health/Medicine, Yale University, New Haven, Connecticut, United States of America
- School of Nursing, Yale University, New Haven, Connecticut, United States of America
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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 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Shamrock OW, Abu-Ba'are GR, Zigah EY, Apreku A, Agbemedu GRK, Boyd DT, Adjaka G, Nelson LE. Family rejection of non-hetero sexuality-Sexual orientation and behavior anonymity among sexual minority men in slum communities-BSGH 001. PLOS Glob Public Health 2023; 3:e0001659. [PMID: 38039264 PMCID: PMC10691700 DOI: 10.1371/journal.pgph.0001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 11/04/2023] [Indexed: 12/03/2023]
Abstract
It can be challenging for sexual minority men (SMM) to decide whether or not to disclose their sexual orientation or behavior. The implications of this decision are significant, especially when considering how their family might react. We interviewed individuals living in slum communities (n = 12) in Accra and Kumasi, Ghana. Our study found that two factors primarily influenced the decision of SMM to disclose their sexual orientation. Firstly, SMM feared facing harm from their families and, secondly, the close ties of SMM families to religious institutions in their communities, which taught against LGBTQ+ activities in the country. These findings contribute to understanding why SMM in Ghanaian slum communities choose to keep their sexual orientation anonymous. While no single intervention is enough to address the challenges associated with coming out, participants in the study agreed that a social support intervention that provides opportunities to educate and inform their families and community on LGBTQ+ activities could help them assimilate comfortably in their communities.
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Affiliation(s)
- Osman Wumpini Shamrock
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Gamji Rabiu Abu-Ba'are
- School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, 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 Medical Center, University of Rochester, Rochester, New York, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, University of Rochester, Rochester, New York, United States of America
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
| | - Amos Apreku
- Behavioral, Sexual and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - George Rudolph Kofi Agbemedu
- Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester Medical Center, 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
| | | | - LaRon E Nelson
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut, United States of America
- School of Nursing, Yale, Connecticut, United States of America
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Zheng Y, Li X, Xia Y, Li X, Yang G, Shi R, Feng Y. Analysis of the Mediation Effects of Adverse Mental Health Outcomes in HIV-Infected Women of Childbearing Age from Multiple Perspectives Including Discrimination Perception. Psychol Res Behav Manag 2023; 16:3447-3459. [PMID: 37664137 PMCID: PMC10473399 DOI: 10.2147/prbm.s421071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To Analysis of the mediation effects of adverse mental health outcomes in HIV-infected women of childbearing age from multiple perspectives including discrimination perception, social capital, and other factors. Methods A cross-sectional survey was conducted among 553 people in Xinjiang region of China using Survey scale. AMOS was used to identify factors that influenced the "discrimination perception/mental resilience/social capital-depression-poor mental health outcomes" pathway. Results A total of 44.85% and 42.13% of the study participants had anxiety and depression symptoms, as perceived discrimination increased, the higher the level of depression in HIV-infected women of childbearing age. Correlation coefficient among depression with poor mental health outcomes was also significant. Psychological resilience, social capital and depression have mediating effects on perceived discrimination and poor mental health outcomes, discrimination perception had an indirect effect on depression through social capital and an indirect effect on adverse mental health outcomes through depression and psychological resilience. The modified model has a good fitting effect. Conclusion Discrimination perception was shown to affect adverse mental health outcomes by impacting mental resilience, depression, and social capital. The findings suggest the need for measures to reduce adverse mental health outcomes by decreasing discrimination perception, increasing social capital, and enhancing psychological resilience.
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Affiliation(s)
- Yinxia Zheng
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
| | - Xianfeng Li
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
| | - Yan Xia
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
| | - Xiaoqin Li
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
| | - Genglin Yang
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
| | - Rui Shi
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
| | - Ying Feng
- Urumqi Maternal and Child Health Hospital, Urumqi, Xinjiang, People’s Republic of China
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Abu-Ba’are GR, Shamrock OW, Apreku A, Agbemedu GRK, Zigah EY, Ezechi OC, Nelson LE, Torpey K. Awareness and Willingness to use Condoms and Preexposure Prophylaxis among Gay, Bisexual, and Other Cisgendered Men who Have sex with men in Slum Communities in Ghana. BSGH-004. J Int Assoc Provid AIDS Care 2023; 22:23259582231209649. [PMID: 37933162 PMCID: PMC10631318 DOI: 10.1177/23259582231209649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Introduction: Research has begun to examine human immunodeficiency virus (HIV) prevention strategies within the Ghanaian context. Still, little is known about specific populations such as gay, bisexual, and other cisgender men who have sex with men (GBMSM) living in slum communities. We studied HIV prevention strategies such as condoms and preexposure prophylaxis (PrEP) in slum communities and the awareness and willingness to use these choices among GBMSM. This qualitative study examines HIV prevention strategies, specifically examining PrEP and condom use behaviors among GBMSM in Ghana. Methods: We conducted in-depth face-to-face interviews among 12 GBMSM from slums in Accra and Kumasi cities in Ghana. Data were analyzed through a summative content analysis with multiple reviewers to develop codes. Data were collected from participants in January 2022. Results: We found the fear and perceived risk of infection were motivators for consistent condom use, especially during anal sex. GBMSM living with HIV receiving antiretroviral therapy were more inclined to use condoms. We found motivations for using PrEP were influenced by the type of sexual activity and a history of negative HIV status. Also, the barriers to PrEP for GBMSM included limited access to healthcare facilities and the distance to these facilities. Conclusions: To improve condom and PrEP access and uptake, we recommend addressing structural barriers by increasing the number of health facilities and implementing targeted interventions to address the lack of information on HIV awareness and prevention. Involving peer educators may also effectively promote HIV prevention strategies, especially in communities with limited access to healthcare such as slums. Overcoming these access constraints could significantly enhance awareness and prevention of HIV, leading to improved health outcomes for GBMSM living in slum communities.
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Affiliation(s)
- Gamji Rabiu Abu-Ba’are
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, University of Ghana, Accra, Ghana
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Osman Wumpini Shamrock
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, USA
| | - Amos Apreku
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | | | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, University of Ghana, Accra, Ghana
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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Appah A, Beelen CJ, Kirkby D, Dong W, Shahid A, Foley B, Mensah M, Ganu V, Puplampu P, Amoah LE, Nii-Trebi NI, Brumme CJ, Brumme ZL. Molecular Epidemiology of HIV-1 in Ghana: Subtype Distribution, Drug Resistance and Coreceptor Usage. Viruses 2022; 15:128. [PMID: 36680168 PMCID: PMC9865111 DOI: 10.3390/v15010128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
The greatest HIV-1 genetic diversity is found in West/Central Africa due to the pandemic’s origins in this region, but this diversity remains understudied. We characterized HIV-1 subtype diversity (from both sub-genomic and full-genome viral sequences), drug resistance and coreceptor usage in 103 predominantly (90%) antiretroviral-naive individuals living with HIV-1 in Ghana. Full-genome HIV-1 subtyping confirmed the circulating recombinant form CRF02_AG as the dominant (53.9%) subtype in the region, with the complex recombinant 06_cpx (4%) present as well. Unique recombinants, most of which were mosaics containing CRF02_AG and/or 06_cpx, made up 37% of sequences, while “pure” subtypes were rare (<6%). Pretreatment resistance to at least one drug class was observed in 17% of the cohort, with NNRTI resistance being the most common (12%) and INSTI resistance being relatively rare (2%). CXCR4-using HIV-1 sequences were identified in 23% of participants. Overall, our findings advance our understanding of HIV-1 molecular epidemiology in Ghana. Extensive HIV-1 genetic diversity in the region appears to be fueling the ongoing creation of novel recombinants, the majority CRF02_AG-containing, in the region. The relatively high prevalence of pretreatment NNRTI resistance but low prevalence of INSTI resistance supports the use of INSTI-based first-line regimens in Ghana.
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Affiliation(s)
- Anna Appah
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
| | - Charlotte J. Beelen
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
| | - Don Kirkby
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
| | - Winnie Dong
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
| | - Aniqa Shahid
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
| | - Brian Foley
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545, USA
| | - Miriam Mensah
- Fevers Unit, Department of Medicine, Korle Bu Teaching Hospital, Accra P.O. Box KB 77, Ghana
| | - Vincent Ganu
- Department of Internal Medicine, Korle Bu Teaching Hospital, Accra P.O. Box KB 77, Ghana
| | - Peter Puplampu
- Department of Internal Medicine, Korle Bu Teaching Hospital, Accra P.O. Box KB 77, Ghana
| | - Linda E. Amoah
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra P.O. Box LG 581, Ghana
| | - Nicholas I. Nii-Trebi
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra P.O. Box LG 25, Ghana
| | - Chanson J. Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada
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Nyblade L, Ndirangu JW, Speizer IS, Browne FA, Bonner CP, Minnis A, Kline TL, Ahmed K, Howard BN, Cox EN, Rinderle A, Wechsberg WM. Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women: conflicting perspectives in South Africa. BMC Public Health 2022; 22:1916. [PMID: 36242000 PMCID: PMC9563466 DOI: 10.1186/s12889-022-14236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/02/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Globally, an urgent need exists to expand access to HIV prevention among adolescent girls and young women (AGYW), but the need is particularly acute in sub-Saharan Africa. Oral pre-exposure prophylaxis (PrEP) offers an effective HIV prevention method. In many countries, however, accessing PrEP necessitates that AGYW visit their local health clinic, where they may face access challenges. Some countries have implemented youth-friendly services to reduce certain challenges in local health clinics, but barriers to access persist, including clinic stigma. However, evidence of clinic stigma toward AGYW, particularly with respect to PrEP service delivery, is still limited. This mixed methods study explores stigma toward AGYW seeking clinic services, in particular PrEP, from the perspective of both clinic staff (clinical and nonclinical) and AGYW who seek services at clinic sites in Tshwane province, South Africa. METHODS Six focus group discussions were conducted with AGYW (43 total participants) and four with clinic staff (42 total participants) and triangulated with survey data with AGYW (n = 449) and clinic staff (n = 130). Thematic analysis was applied to the qualitative data and descriptive statistics were conducted with the survey data. RESULTS Four common themes emerged across the qualitative and quantitative data and with both AGYW and clinic staff, although with varying degrees of resonance between these two groups. These themes included (1) clinic manifestations of stigma toward AGYW, (2) concerns about providing PrEP services for AGYW, (3) healthcare providers' identity as mothers, and (4) privacy and breaches of confidentiality. An additional theme identified mainly in the AGYW data pertained to stigma and access to healthcare. CONCLUSION Evidence is needed to inform strategies for addressing clinic stigma toward AGYW, with the goal of removing barriers to PrEP services for this group. While awareness has increased and progress has been achieved around the provision of comprehensive, youth-friendly sexual and reproductive health services, these programs need to be adapted for the specific concerns of young people seeking PrEP services. Our findings point to the four key areas noted above where programs seeking to address stigma toward AGYW in clinics can tailor their programming.
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Affiliation(s)
- Laura Nyblade
- grid.62562.350000000100301493Global Health Division, RTI International, Washington, DC USA
| | - Jacqueline W. Ndirangu
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Ilene S. Speizer
- grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Felicia A. Browne
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Courtney Peasant Bonner
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Alexandra Minnis
- grid.62562.350000000100301493Women’s Global Health Imperative, RTI International, Berkeley, CA USA ,grid.47840.3f0000 0001 2181 7878School of Public Health, University of California, Berkeley, CA USA
| | - Tracy L. Kline
- grid.62562.350000000100301493Social Statistics Program, RTI International, Research Triangle Park, NC USA
| | - Khatija Ahmed
- grid.477887.3Setshaba Research Centre, Tshwane, South Africa ,grid.49697.350000 0001 2107 2298Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Brittni N. Howard
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Erin N. Cox
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA
| | - Abigail Rinderle
- grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Wendee M. Wechsberg
- grid.62562.350000000100301493Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.40803.3f0000 0001 2173 6074Department of Psychology, North Carolina State University, Raleigh, NC USA ,grid.26009.3d0000 0004 1936 7961Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
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Stackpool-Moore L, Logie CH, Cloete A, Reygan F. What will it take to get to the heart of stigma in the context of HIV? J Int AIDS Soc 2022; 25 Suppl 1:e25934. [PMID: 35818934 PMCID: PMC9274335 DOI: 10.1002/jia2.25934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lucy Stackpool-Moore
- IAS - International AIDS Society, Geneva, Switzerland.,Watipa, Sydney, New South Wales, Australia
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
| | - Allanise Cloete
- Human and Social Capabilities Division, Human Sciences Research Council, Cape Town, South Africa
| | - Finn Reygan
- Human and Social Capabilities Division, Human Sciences Research Council, Pretoria, South Africa
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