Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

• Type of Material: Article
• Authors: John M Wiginton, Johns Hopkins Bloomberg School of Public Health; Sarah M Murray, Johns Hopkins Bloomberg School of Public Health; Ohemaa Poku, Johns Hopkins Bloomberg School of Public Health; Jura Augustinavicius, Johns Hopkins Bloomberg School of Public Health; Kevon-Mark Phillip Jackman, Johns Hopkins Bloomberg School of Public Health; Jeremy Kane, Mailman School of Public Health; Serge C Billong, Université de Yaoundé I; Daouda Diouf, Enda Santé; Ibrahima Ba, Enda Santé; Tampose Mothopeng, People’s Matrix Association; Iliassou Mfochive Njindam, Johns Hopkins Bloomberg School of Public Health; Gnilane Turpin, Johns Hopkins Bloomberg School of Public Health; Ubald Tamoufe, Metabiota, Inc.; Bhekie Sithole, FHI 360, Mbabane; Maria Zlotorzynska, Emory University; Travis Sanchez, Emory University; Stefan D Baral, Johns Hopkins Bloomberg School of Public Health
• Language: English
• Date: 2021-12-01
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021, corrected publication 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-021-12151-3
• Title of Journal or Parent Work: BMC Public Health
• Volume: 21
• Issue: 1
• Start Page: 2206
• End Page: 2206
• Grant/Funding Information: This study was funded by National Institutes of Health (R01MH110358). This study received ethical approval from within-country ethics committees and institutional review boards, and from a US-based academic institution’s institutional review board.
• Keywords: Male; Sexual and Gender Minorities; Men who have sex with men; Delivery of Health Care; Disclosure; Humans; Healthcare stigma; Sexual Behavior; Social Stigma; HIV Infections; Sub-Saharan Africa; Homosexuality, Male
• Research Categories: Health Sciences, Mental Health; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background: For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. Methods: We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d’Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. Results: Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. Conclusions: Research to determine the factors driving disclosure’s differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.