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

Abstract

In sub-Saharan Africa, men who have sex with men (MSM) are socially, largely hidden and face disproportionate risk for HIV infection. Attention to HIV epidemics among MSM in Uganda and elsewhere in sub-Saharan Africa has been obscured by repressive governmental policies, criminalisation, stigma and the lack of basic epidemiological data describing these epidemics. In this paper, we aim to explore healthcare access, experiences with HIV prevention services and structural barriers to using healthcare services in order to inform the acceptability of a combination HIV prevention package of services for men who have sex with men in Uganda. We held focus group discussions (FGDs) with both MSM and healthcare providers in Kampala, Uganda, to explore access to services and to inform prevention and care. Participants were recruited through theoretical sampling with criteria based on ability to answer the research questions. Descriptive thematic coding was used to analyse the FGD data. We described MSM experiences, both negative and positive, as they engaged with health services. Our findings showed that socio-structural factors, mediated by psychological and relational factors impacted MSM engagement in care. The socio-structural factors such as stigma, homophobia and policy issues emerged strongly as did the mediating factors such as relations with specific health staff and a social support structure. A combination intervention addressing structural, social and psychological barriers could have an impact even in the precarious policy environment where this study was conducted.

Cultural and clinical challenges in sexual health care provision to men who have sex with men in Tanzania: a qualitative study of health professionals’ experiences and health students’ perspectives

“…These factors act as barriers in accessing healthcare services by lesbian, gay, bisexual and transgender (LGBT) populations [27,38,39]. Furthermore, same sex relationships in sub-Saharan Africa are heavily stigmatized and criminalized in many countries in the continent [40,41]. Two studies conducted in Eastern Africa revealed that MSM encounter several barriers towards accessing health care services due to their sexual orientation.…”

“…Two studies conducted in Eastern Africa revealed that MSM encounter several barriers towards accessing health care services due to their sexual orientation. These include being denied medications or provided with expired medications [27,41], and in some instances, addressed as mentally ill patients or as "psychotic" [41,42]. Because of the judgmental attitudes, discrimination, sociocultural and religious beliefs exerted by health care providers, MSM remain fearful in seeking health care services [27,[40][41][42][43].…”

“…These include being denied medications or provided with expired medications [27,41], and in some instances, addressed as mentally ill patients or as "psychotic" [41,42]. Because of the judgmental attitudes, discrimination, sociocultural and religious beliefs exerted by health care providers, MSM remain fearful in seeking health care services [27,[40][41][42][43]. This results in a continuous rise of HIV and STIs among this subpopulation in Africa as evidenced by a recent study conducted in Nigeria where the trend for HIV infection among MSM rose from 14 to 23% from the year 2007 to 2014 [44].…”

Cost-Effectiveness of Peer-Delivered HIV Self-Tests for MSM in Uganda

“…A mathematical model suggests that the biggest reductions in HIV incidence in Sub-Saharan Africa will occur through increased coverage of HIV testing and effective treatment of people living with HIV (5). In Uganda, HIV testing uptake among men is low (55%) compared to 82% among women (6). No data are available regarding HIV testing coverage among MSM in Uganda where same sex relationships are criminalized through colonial-era laws (7,8).…”

“…The Anti-Homosexuality Act was passed in 2014 but subsequently overturned by the Constitutional Court of Uganda (7,8). However, social and healthcare stigma and discrimination still hamper key population access to HIV prevention services (6) despite the fact that the Uganda Ministry of Health prohibits discrimination of key populations (7,8).…”