Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

BMC Public Health

Stefan D. Baral¹  Iliassou Mfochive Njindam²  Gnilane Turpin²  Jeremy Kane³  Travis H. Sanchez⁴  Maria Zlotorzynska⁴  John Mark Wiginton⁵  Kevon-Mark Phillip Jackman⁶  Jura Augustinavicius⁶  Ohemaa Poku⁶  Sarah M. Murray⁶  Serge C. Billong⁷  Daouda Diouf⁸  Ibrahima Ba⁸  Bhekie Sithole⁹  Ubald Tamoufe^1,10  Tampose Mothopeng^1,11 

[1] Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA;Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA;Metabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon;Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY, USA;Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA;Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway Street, 21205, Baltimore, MD, USA;Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA;Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon;Enda Santé, Dakar, Senegal;FHI 360, Mbabane, Mbabane, eSwatini;Metabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon;The People’s Matrix, Maseru, Lesotho;

关键词: Disclosure;    Healthcare stigma;    Men who have sex with men;    Sub-Saharan Africa;   

DOI  :  10.1186/s12889-021-12151-3

来源: Springer

【 摘 要 】

BackgroundFor men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma.MethodsWe performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d’Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data.ResultsCompared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations.ConclusionsResearch to determine the factors driving disclosure’s differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.

【 授权许可】

CC BY