Strengthening healthcare providers’ skills to improve HIV services for MSM in Kenya

Elst, Elise van der; Gichuru, Evans; Muraguri, Nicolas; Musyoki, Helgar; Micheni, Murugi; Kombo, Bernadette; Smith, Adrian D.; Graham, Susan M.; Sanders, Eduard J.; Operario, Don

doi:10.1097/qad.0000000000000882

Cited by 25 publications

(20 citation statements)

References 26 publications

(24 reference statements)

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“…Facilitated conversations were at the center of the activities. Harro’s conceptual framework, ‘the cycle of socialization’, is closely compatible with our prior cross-cultural work with African health care providers on GBMSM stigma (van der Elst, Gichuru et al, 2013 ; van der Elst, Gichuru et al, 2015 ; van der Elst, Kombo et al, 2015 ; van der Elst, Smith et al, 2013 ), and the literature on GBMSM stigma (Dijkstra et al, 2015 ). The model built on a set of concepts, deriving from the introductory guide for health care providers working with GBMSM in Africa (Brown, Duby, Scheibe, & Sanders, 2011 ), and emphasized the overarching context of stigma and discrimination, linked to religious leaders’ attitudes, offering possible courses of action to ‘choose the direction to change’, interrupt the cycle of socialization and potentially dismantle GBMSM oppression.…”

Section: Methodsmentioning

confidence: 57%

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

Gichuru

Kombo

Mumba

et al. 2018

Critical Public Health

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In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders’ discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM.

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Section: Methodsmentioning

confidence: 57%

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

Gichuru

Kombo

Mumba

et al. 2018

Critical Public Health

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“…Key structural factors included perceived staff attitudes, a lack of quality assurance, a lack of data protection and confidentiality, and cost [31,32,37,40,50,52]. Apart from addressing stigma and general competency to provide MSM with PrEP among healthcare providers in LMICwhich have been noted by others [83,84] our results suggest that strengthening health systems so as to assure universal provision of high-quality PrEP, while protecting the identities of MSM, will be critical. Strengthening drug regulation in middle-income countries has also been highlighted as essential by other authors [85].…”

Section: Discussionmentioning

confidence: 68%

Awareness and willingness to use HIV pre‐exposure prophylaxis among men who have sex with men in low‐ and middle‐income countries: a systematic review and meta‐analysis

Tuot²,

Mwai³

et al. 2017

Journal of the International AIDS Society

134

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Introduction: To facilitate provision of pre-exposure prophylaxis (PrEP) in low- and middle-income countries (LMIC), a better understanding of potential demand and user preferences is required. This review assessed awareness and willingness to use oral PrEP among men who have sex with men (MSM) in LMIC.Methods: Electronic literature search of Cochrane library, Embase, PubMed, PsychINFO, CINHAL, Web of Science, and Google Scholar was conducted between July and September 2016. Reference lists of relevant studies were searched, and three authors contacted for additional data. Non-peer reviewed publications were excluded. Studies were screened for inclusion, and relevant data abstracted, assessed for bias, and synthesized.Results: In total, 2186 records were identified, of which 23 studies involving 14,040 MSM from LMIC were included. The proportion of MSM who were aware of PrEP was low at 29.7% (95% CI: 16.9–44.3). However, the proportion willing to use PrEP was higher, at 64.4% (95% CI: 53.3–74.8). Proportions of MSM aware of PrEP was <50% in 11 studies and 50–70% in 3 studies, while willingness to use PrEP was <50% in 6 studies, 50–70% in 9 studies, and over 80% in 5 studies. Several factors affected willingness to use PrEP. At the individual domain, poor knowledge of PrEP, doubts about its effectiveness, fear of side effects, low perception of HIV risk, and the need to adhere or take medicines frequently reduced willingness to use PrEP, while PrEP education and motivation to maintain good health were facilitators of potential use. Demographic factors (education, age, and migration) influenced both awareness and willingness to use PrEP, but their effects were not consistent across studies. At the social domain, anticipated stigma from peers, partners, and family members related to sexual orientation, PrEP, or HIV status were barriers to potential use of PrEP, while partner, peer, and family support were facilitators of potential use. At the structural domain, concerns regarding attitudes of healthcare providers, quality assurance, data protection, and cost were determinants of potential use.Conclusions: This review found that despite low levels of awareness of PrEP, MSM in LMIC are willing to use it if they are supported appropriately to deal with a range of individual, social, and structural barriers.

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“…If the Kenyan MoH PrEP guidelines can be updated to include RAI as an indicator for PrEP eligibility, this would help normalize discussions on anal sex and ensure that all individuals at high risk for HIV-1 acquisition are offered PrEP. In addition, sensitization training of health care providers should be facilitated to reduce homophobic attitudes [20] and improve MSM healthcare services [21].…”

Section: Discussionmentioning

confidence: 99%

“…In 2017, we developed an empiric risk score to guide PrEP targeting among at-risk MSM who were followed in a vaccine feasibility study and had an HIV-1 incidence of 7.0 (95% confidence interval [CI], 5.8-8.6) per 100 person-years. Characteristics of the cohort-derived HIV-1 risk score (CDHRS) included having only male sex partners, RAI, any recent unprotected sex, group sex, and young age (18)(19)(20)(21)(22)(23)(24) years) [7]. Although the CDHRS tool had a good performance in detecting HIV-1 acquisition among MSM eligible for PrEP in this cohort, we were interested to compare it to the performance of the MoH PrEP risk criteria to identify at-risk MSM for PrEP uptake in this cohort.…”

Section: Introductionmentioning

confidence: 99%

Assessment of PrEP eligibility and uptake among at-risk MSM participating in a HIV-1 vaccine feasibility cohort in coastal Kenya

Wahome

Graham

Thiong'o³

et al. 2019

Preprint

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Introduction Pre-exposure prophylaxis (PrEP) is provided free of costs to a broad range of at-risk populations in Kenya, including men who have sex with men (MSM), but anal intercourse is not an eligibility criterion. We set out to determine PrEP eligibility, uptake and predictors of PrEP uptake among MSM enrolled in an HIV-1 vaccine feasibility cohort in coastal Kenya. Methods We compared the number of MSM identified as eligible for PrEP from June - December 2017 by Kenyan Ministry of Health (MoH) criteria, which do not include reported anal intercourse, to those identified as eligible by a published MSM cohort-derived HIV-1 risk score (CDHRS). We determined PrEP uptake and assessed factors associated with PrEP uptake at first offer among eligible MSM followed up monthly for HIV-1 testing, risk assessment, and risk reduction counselling. Results Out of 167 MSM assessed for PrEP eligibility, 118 (70.7%) were identified by both MoH and CDHRS eligibility criteria. However, the CDHRS identified 33 (19.8%) more cohort MSM for PrEP eligibility than the MoH criteria, of whom the majority (24 or 72.7%) reported receptive anal intercourse (RAI). Of the 162 MSM eligible for PrEP, 113 (69.7%) accepted PrEP at first offer. Acceptance of PrEP was higher for men reporting RAI (adjusted prevalence ratio [aPR], 1.4; 95% confidence interval [CI], 1.0–1.9), having paid for sex (aPR, 1.3; 95% CI, 1.1–1.6) and group sex (aPR, 1.4; 95% CI, 1.1–1.8), after adjustment for sociodemographic factors. Conclusions Assessing PrEP eligibility using a CDHRS identified 20% more at-risk MSM for PrEP initiation than when Kenyan MoH criteria were used. Approximately 70% of eligible men accepted PrEP at first offer, suggesting that PrEP is acceptable among at-risk MSM. MSM reporting RAI, group sex, or paying for sex were more likely to accept PrEP, reinforcing the importance of an informed discussion of HIV-1 risk during PrEP counselling.

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Strengthening healthcare providers’ skills to improve HIV services for MSM in Kenya

Cited by 25 publications

References 26 publications

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

Awareness and willingness to use HIV pre‐exposure prophylaxis among men who have sex with men in low‐ and middle‐income countries: a systematic review and meta‐analysis

Assessment of PrEP eligibility and uptake among at-risk MSM participating in a HIV-1 vaccine feasibility cohort in coastal Kenya

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