Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

Gu, Lily Y.; Zhang, Nanhua; Mayer, Kenneth H.; McMahon, James M.; Nam, Soohyun; Conserve, Donaldson F.; Moskow, Marian; Brasch, Judith; Adu‐Sarkodie, Yaw; Agyarko-Poku, Thomas; Boakye, Francis; Nelson, LaRon E.

doi:10.1177/2325958220978113

Cited by 15 publications

(19 citation statements)

References 68 publications

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“…Multiple HIV HCF stigma-reduction interventions are available [21,22,24,[28][29][30][31][32], and a few studies have developed interventions to address MSM stigma [33][34][35]. However, interventions to address intersectional (HIV, same-sex and gender non-conformity) stigma faced by MSM, particularly in West Africa, are limited [9,23,36].…”

Section: Introductionmentioning

confidence: 99%

“…HCWs and healthcare facilities (HCFs) are essential to HIV prevention, care and treatment. They can also be sources of stigma for both PLHIV and KPs [21,22], who have reported dismissive attitudes, coerced procedures and refusal to deliver treatment [2,6,23,24]. In an HCF study in Ghana, 29% of HCWs indicated that if given the choice, they would prefer not to provide services to MSM [6] .…”

Section: Introductionmentioning

confidence: 99%

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Using a mixed‐methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana

et al. 2022

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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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using a mixed‐methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana

et al. 2022

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“…Interventions must be strengthened to increase the encouragement of HIV-infected women to use contraception in Togo [9]. Although the awareness rate of HIV transmission prevention knowledge and the autonomy of sexual behavior protection among the PLHA population in my country have increased [10], they were affected by the demographic characteristics and related knowledge in different regions [11]. If you had multiple sexual partners for a long time, the proportion of meeting contraceptive needs was not high, which would increase the risk of sexual partners contracting HIV [12].…”

Section: Related Workmentioning

confidence: 98%

[Retracted] The Fertility Status of the Married People Living with HIV/AIDS in China

Que

et al. 2022

Contrast Media & Molecular Imaging

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In order to analyze the fertility status of the married people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLHA) of reproductive age in China, a sample of married PLHAs aged 22–45 in China is selected by using a stratified cluster sampling method. All participants are face-to-face interviewed with a structured questionnaire. Among them, the fertility status and its influencing factors of 366 PLHAs are statistically analyzed. Experimental results show that married PLHA of reproductive age in China has a high proportion of having children. The fertility status and fertility intention of females are higher than that of males. The proportion of unwanted pregnancies after the HIV + diagnosis of females is high.

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“…In a seminal study, MSM in Ghana reported they felt they could not share their sexual identity while seeking care at a health care facility (HCF) and, instead, preferred not to seek care to avoid the discomfort (6). Although the avoidance of HCFs is a protective behavioral strategy used by MSM to avoid exposure to sexual stigma (22), it can have indirect residual impacts on their health through either the lack of detection or delayed detection and treatment of chronic or communicable disease (22,23).…”

Section: Introductionmentioning

confidence: 99%

Multi-level Manifestations of Sexual Stigma among Men with Same-Gender Sexual Experience in Ghana

Saalim

Adu²,

Amoh-Otu³

et al. 2022

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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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Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

Cited by 15 publications

References 68 publications

Using a mixed‐methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana

Using a mixed‐methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana

[Retracted] The Fertility Status of the Married People Living with HIV/AIDS in China

Multi-level Manifestations of Sexual Stigma among Men with Same-Gender Sexual Experience in Ghana

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