The lived experiences of men who have sex with men when accessing HIV care services in Zimbabwe

Abstract

Key populations are disproportionately affected by human immunodeficiency virus (HIV) but under-represented in HIV testing and treatment programmes (World Health Organization [WHO] 2017:15). In spite of the fact that key populations constitute a small proportion of the general population globally, statistics indicate that in 2018, more than half (54%) of the new infections were from key populations and their partners (UNAIDS 2019a). To achieve HIV epidemic control, it is critical that key populations have access to HIV care services, which include testing, treatment and retention in care and maintaining undetectable viral load. In addition, according to UNAIDS (2019a:9), available data indicated that in 2018 the risk of acquiring HIV by men who have sex with other men (MSM) was 22 times higher than amongst all adult men, and 17% of new infections were from this group globally. Despite this, key population groups such as MSM are underserved. The concealed nature of many key populations, stigma and discrimination and criminalisation of their behaviour make it difficult to track various steps along the HIV care continuum (UNAIDS 2019b:6-7).UNAIDS data show that, in eastern and southern Africa, there has been a significant decline in the number of new HIV infections and AIDS-related deaths. However, in 2018, 25% of the new infections in these regions were from key populations and their partners. According to UNAIDS, it is estimated that 37.9 million people were living with HIV, and there were 1.7 million new infections globally at the end of 2018. The UNAIDS 2019 Data Report highlighted the fact that sub-Saharan Africa is still at the epicentre of the global HIV epidemic, with 61% of all HIV new infections occurring in this region in 2018. The top five countries being Swaziland (27.3%), South Africa (20.4%), Botswana (20.3%), Zimbabwe (12.7%) and Malawi (9.2%) (UNAIDS 2019a:35-73).Background: Key populations such as men who have sex with men are disproportionately affected by human immunodeficiency virus (HIV), yet they are underserved. This vulnerable group also faces stigma and discrimination when utilising the healthcare services. However, to achieve the HIV epidemic control, it is important for them to have access to HIV care services. Aim:The aim of this study was to explore and describe the experiences of men who have sex with men (MSM) as they accessed HIV care services in healthcare settings in Bulawayo, Zimbabwe. Setting:The study setting was healthcare facilities (state and private owned) in Bulawayo, Zimbabwe, that offer HIV care services. Methods:The study used a descriptive phenomenological design targeting self-identified MSM living with HIV. Data were gathered by using in-depth individual interviews that were audio recorded. Data saturation determined sample size. Data were transcribed verbatim and later analysed thematically. Results:The study revealed that counselling given to MSM was generalised and not individualised. Some clients faced stigma and discrimination after disclosure. Peer and family su...

Stigma, Social Cohesion, and HIV Risk Among Sexual and Gender Minorities in Two Cities in Zimbabwe

“…Similar initiatives may be considered for Zimbabwean SGM, given that avoidance of healthcare services and concealment of SGM status while seeking healthcare were two of the most commonly reported acts of stigma in our study. Similarly, findings from a qualitative study describing the experience of MSM accessing HIV services in Bulawayo, Zimbabwe indicated that MSM who disclosed their sexual orientation often experienced stigmatization by healthcare providers, leading to fear of seeking services [51]. While mitigating healthcare-related stigma is critical, as Mutanga and Moen describe in their 2019 qualitative analysis of sexuality-related stigma among gay and bisexual men in Zimbabwe, reducing stigma among SGMs in this context requires multifaceted interventions targeting stigma at the individual, community, and government levels [25].…”

Oral Pre-Exposure Prophylaxis Accessibility, Knowledge, Barriers, and Facilitators Among Men Who Have Sex With Men in Bulawayo, Zimbabwe

“…These numbers are alarming, hence the need for MSM to access sexual and reproductive health services (SRHS) because curbing the HIV epidemic cannot be possible without reaching this population ( Gupta & Granich, 2017 ). Accessing SRHS such as PrEP by MSM in Bulawayo is highly influenced by barriers such as discrimination, stigma and social exclusion ( Moyo et al, 2021 ), and the existence of public health care facilities that have no standardized services that cater for the needs of MSM ( Munyimani & Nunu, 2022 ). This research article aims to explore the accessibility of PrEP, knowledge of PrEP among MSM, potential barriers, and facilitators to improve PrEP uptake among this population.…”

Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa

“…Fourteen articles13 68–80 were partially intersectional stigma studies incorporating an intersectional approach to some elements of the analysis or presentation of their findings. We also identified 10 articles81–90 that studied multiple stigmas in a non-intersectional manner and 142 articles4 13 16–18 21 51 52 91–224 that studied one stigma in one population of SGM or studied one stigma in each of multiple populations (eg, SSSAB stigma only among MSM and transgender stigma only among TGW). A summary of each intersectional stigma study (n=21) appears in online supplemental file 2 and a summary of each non-intersectional stigma study (n=152) appears in online supplemental file 3.…”