Stigma, Health Care Access, and HIV Knowledge Among Men Who Have Sex With Men in Malawi, Namibia, and Botswana
First Online: 10 December 2010 DOI:
Cite this article as: Fay, H., Baral, S.D., Trapence, G. et al. AIDS Behav (2011) 15: 1088. doi:10.1007/s10461-010-9861-2 Abstract
Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.
Keywords Stigma Discrimination HIV/AIDS Men who have sex with men (MSM) Namibia Botswana Malawi References
Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDS. 2007;21(8):584–92.
Amirkhanian YA, Kelly JA, McAuliffe TL. Psychosocial needs, mental health, and HIV transmission risk behavior among people living with HIV/AIDS in St Petersburg, Russia. AIDS. 2003;17(16):2367–74. Nov 7.
The Lancet Infectious Diseases. Rights of vulnerable people and the future of HIV/AIDS. Lancet Infect Dis. 2010;10(2):67.
Goffman E. Stigma: notes on the management of spoiled identity. Harmondsworth: Penguin; 1963.
Malcolm A, Aggleton P, Bronfman M, Galvão J, Mane P, Verrall J. HIV-related stigmatization and discrimination: its forms and contexts. Crit Public Health. 1998;8(4):347–70.
Link BG, Phelan JC. Conceptualizing stigma. Annu Rev Sociol. 2001;27:363–85.
Jacoby A. Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Soc Sci Med. 1994;38(2):269–74.
Baral S, Trapence G, Motimedi F, et al. HIV prevalence, risks for HIV infection, and human rights among men who have sex with men (MSM) in Malawi, Namibia, and Botswana. PLoS One. 2009;4(3):e4997.
Zulu KP, Bulawo ND, Zulu W. Understanding HIV risk behaviour among men who have sex with men in Zambia. XVI International AIDS Conference. 13–18 August. Toronto, Ontario (Abstract WEPE0719). 2006.
Sanders EJ, Graham SM, Okuku HS, et al. HIV-1 infection in high risk men who have sex with men in Mombasa, Kenya. AIDS. 2007;21(18):2513–20. Nov 30.
Wade AS, Kane CT, Diallo PA, et al. HIV infection and sexually transmitted infections among men who have sex with men in Senegal. AIDS. 2005;19(18):2133–40. Dec 2.
IGLHRC. Off the map: how HIV/AIDS programming is failing same-sex practicing people in Africa, 2007.
Ntata PR, Muula AS, Siziya S. Socio-demographic characteristics and sexual health related attitudes and practices of men having sex with men in central and southern Malawi. Tanzan J Health Res. 2008;10(3):124–30.
Caceres CF, Konda K, Segura ER, Lyerla R. Epidemiology of male same-sex behaviour and associated sexual health indicators in low- and middle-income countries: 2003–2007 estimates. Sex Transm Infect. 2008;84(Suppl 1):i49–56.
Lane T, Mogale T, Struthers H, McIntyre J, Kegeles SM. “They see you as a different thing”: the experiences of men who have sex with men with healthcare workers in South African township communities. Sex Transm Infect. 2008;84(6):430–3.
Sharma A, Bukusi E, Gorbach P, et al. Sexual identity and risk of HIV/STI among men who have sex with men in Nairobi. Sex Transm Dis. 2008;35(4):352–4.
van Griensven F, Sanders EJ. Understanding HIV risks among men who have sex with men in Africa. Sex Transm Dis. 2008;35(4):355–6.
Cloete A, Simbayi LC, Kalichman SC, Strebel A, Henda N. Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa. AIDS Care. 2008;20(9):1105–10.
Elrashied S. Prevalence, knowledge and related risky sexual behaviors of HIV/AIDS among receptive men who have sex with men (MSM) in Khartoum State, Sudan; 2006; Toronto, Canada: In: AIDS 2006—XVI International AIDS Conference; 2005.
Zulu KP. Anal sex and HIV—an ignored tragedy, a case in Zambia; 2006; Toronto, Canada: In: The 3rd IAS Conference on HIV Pathogenesis and Treatment.
Ullrich PM, Lutgendorf SK, Stapleton JT. Concealment of homosexual identity, social support and CD4 cell count among HIV-seropositive gay men. J Psychosom Res. 2003;54(3):205–12.
Strachan ED, Bennett WR, Russo J, Roy-Byrne PP. Disclosure of HIV status and sexual orientation independently predicts increased absolute CD4 cell counts over time for psychiatric patients. Psychosom Med. 2007;69(1):74–80.
Orasure Technologies, Bethleham, PA, USA.
Stata Corp. Stata statistical software: release 10. College Station, TX: Stata Corporation; 2007.
Subbiah M, Srinivasan MR. Classification of 2 × 2 sparse data sets with zero cells. Statist Probabil Lett. 2008;78:3212–5.
Johnson WD, Diaz RM, Flanders WD et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev 2008 Jul 16;(3):CD001230.
Auvert B et al. Is genital human papillomavirus infection associated with HIV incidence? 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, abstract TUAC202, 2009.
Chakrapani V, Newman PA, Shunmugam M, McLuckie A, Melwin F. Structural violence against Kothi-identified men who have sex with men in Chennai, India: a qualitative investigation. AIDS Educ Prev. 2007;19(4):346–64.
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