HIV care engagement and ART adherence among Kenyan gay, bisexual, and other men who have sex with men: a multi-level model informed by qualitative research

Abstract

Gay, bisexual, and other men who have sex with men (GBMSM) are highly stigmatized and male–male sex is often criminalized in sub-Saharan Africa, impeding access to quality care for sexual health, HIV prevention, and treatment. To better understand HIV care engagement and antiretroviral therapy (ART) adherence among GBMSM in this context, a conceptual model incorporating sociocultural factors is needed. We conducted a qualitative study of barriers to and facilitators of HIV care engagement and ART adherence among Kenyan GBMSM, informed by a conceptual model based on an access, information, motivation, and behavioral skills (access-IMB) model, with trust in providers and stigma and discrimination as a priori factors of interest. We conducted 30 semi-structured interviews with HIV-positive Kenyan GBMSM, of whom 20 were taking ART and 10 had not yet initiated treatment. A deductive approach was used to confirm the relevance of basic concepts of the access-IMB model, while an inductive approach was used to identify content that emerged from men’s lived experiences. Access-related information, motivation, and behavioral skills appeared relevant to HIV care engagement and ART adherence, with stigma and discrimination appearing consistently across discourse exploring facilitators and barriers. Trusted providers and supportive family and friends helped many men, and resilience-related concepts such as selective disclosure of GBMSM status, connection to lesbian, gay, bisexual, and transgender (LGBT) organizations, self-acceptance, goal-setting, social identity and altruism emerged as important facilitators. Findings suggest a need to increase support from providers and peers for Kenyan GBMSM living with HIV infection. In addition, they point toward the potential value of interventions that provide opportunities to build or enhance one’s sense of community belonging in order to improve HIV care engagement and promote ART adherence for this vulnerable population.

Crowdsourcing contests to facilitate community engagement in HIV cure research: a qualitative evaluation of facilitators and barriers of participation

“…We found that stigma constrained participation in crowdsourcing contests. This finding is consistent with prior research which found HIV-related stigma negatively impacts community engagement in HIV research [35][36][37]. Stigma associated with discussing HIV in public settings was closely connected to broader social inequalities of gender, sexuality, and class.…”

Human Papillomavirus awareness and vaccine acceptability among men who have sex with men from mainland China

“…This study revealed that 36.5% of the participants ever had sex with women. It was close to similar studies from China, with a proportion between 27% and 56%, but it was higher than a similar study in the USA, which showed 20% of the participants ever had sex with female partners 5,29–32 . Apart from 20.1% of the study participants were self-reported bisexuality, another explanation could not be excluded.…”

How men who have sex with men experience HIV health services in Kampala, Uganda

“…Facilitators to health service access In Kenya, Graham and colleagues found that identifying providers and family or friends as well as engaging with trusted LGBTI organisations, assisted many men with accepting and disclosing their sexual identity. 32 Our findings also highlighted the importance of providerpatient trust in health service utilisation and the role that training in gender diversity can have in building trusting relationships.…”

“…Findings from studies in other African countries (Kenya, Botswana, Namibia, Malawi, South Africa and Swaziland) show the disproportionate burden of HIV and the influence of stigma on health seeking behaviour. [32][33][34][35][36] As has been discussed, since early in the HIV epidemic, stigmatisation of marginalised populations influences healthcare utilisation in a myriad of ways, including fear of seeking healthcare, lack of disclosure of same sex relationships to healthcare providers, denial of services related to one's sexuality. 33 A global online survey of over 4000 participants evaluated the effect of the enforcement of laws criminalising homosexuality on access to services and found that arrests and convictions under laws applicable to being MSM had a strong negative association with use of HIV prevention and care services with the strongest effects in sub-Saharan Africa.…”