“But the moment they find out that you are MSM…”: a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana’s health care system

BMC Public Health

Research Article

Adedotun Ogunbajo¹  Nanhua Zhang²  Yaw Adu-Sarkodie³  Thomas Agyarko-Poku³  Francis Boakye⁴  Leo Wilton⁵  Yasmin Lalani⁶  Geoffrey Maina⁷  Sameer Kushwaha⁸  LaRon E. Nelson⁹ 

[1] Brown University, Providence, RI, USA;Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA;Kwame Nkrumah University of Science & Technology, Kumasi, Ashanti, Ghana;Priorities on Rights and Sexual Health, Accra, Ghana;State University of New York at Binghamton, Binghamton, NY, USA;University of Johannesburg, Johannesburg, South Africa;University of Rochester, Rochester, NY, USA;University of Saskatchewan, College of Nursing, 214-1301 Central Avenue, Prince Albert, SK, Canada;University of Toronto, Toronto, ON, Canada;University of Toronto, Toronto, ON, Canada;University of Rochester, Rochester, NY, USA;St. Michael’s Hospital, Centre for Urban Health Solutions, Toronto, ON, Canada;

关键词: Ghana;    HIV prevention;    Health care providers;    Men who have sex with men (MSM);    Stigma;    Self-determination theory;    Health care climate;    Sexual health;   

DOI  :  10.1186/s12889-017-4799-1

 received in 2016-12-06, accepted in 2017-09-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM’s experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM’s use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities.MethodsWe conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM.ResultsThere were four major findings related to MSM experiences using HIV prevention resources: (1) condom quality is low, condom access is poor, and condom use is disruptive, (2) inaccurate information undermines HIV testing (3), stigma undermines HIV testing, and (4) positive attitudes towards HIV prevention exist among MSM. The main healthcare climate factors that affected prevention were that MSM were not free to be themselves, MSM were not understood by healthcare providers, and that MSM did not feel that healthcare providers cared about them. To improve HIV prevention MSM suggested increased education tailored to MSM should be provided to enable self-advocacy and that education and awareness are needed to protect human rights of MSM in Ghana.ConclusionMSM in Ghana are exposed to negative health care climates. Health care spaces that are unsupportive of MSM’s autonomy undermine the uptake of prevention measures such as condoms, HIV testing, and accurate sexual health education. These findings contribute to knowledge to inform development of HIV prevention interventions for MSM in Ghana, such as culturally appropriate sexual health education, and digital technology to connect individuals with resources supportive of MSM.

【 授权许可】

CC BY   
© The Author(s). 2017