Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa

Embleton, Lonnie; Logie, Carmen H.; Ngure, Kenneth; Nelson, LaRon E.; Kimbo, Liza; Ayuku, David; Turan, Janet M.; Braitstein, Paula

doi:10.1007/s10461-022-03793-4

Cited by 22 publications

(20 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Research describing sexual stigma among men with same-gender sexual experiences in Ghana is limited and has focused primarily on occurrences at the interpersonal level [6,[24][25][26]. However; there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at structural and organizational levels [27]. The interactions among these multiple levels of sexual stigma are important to identify and understand because they may undermine the development of positive self-concept and maintenance of psychological well-being among the men [28][29][30].…”

Section: Introductionmentioning

confidence: 99%

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana

et al. 2023

View full text Add to dashboard Cite

Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated [1] what was the range of sexual stigma manifestations, and [2] how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.

show abstract

Section: Introductionmentioning

confidence: 99%

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Research describing sexual stigma among men with same-gender sexual experiences in Ghana is limited and has focused primarily on occurrences at the interpersonal level (6, 24-26). However; there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at structural and organizational levels (27). The interactions among these multiple levels of sexual stigma are important to identify and understand because they may undermine the development of positive selfconcept and maintenance of psychological well-being among the men (28-30).…”

Section: Introductionmentioning

confidence: 99%

Multi-level Manifestations of Sexual Stigma among Men with Same-Gender Sexual Experience in Ghana

Saalim

Adu²,

Amoh-Otu³

et al. 2022

Preprint

View full text Add to dashboard Cite

Sexual stigma and discrimination toward men who have same-gender sexual experiences are present across the globe. In Ghana, same-gender sexual desires and relationships are stigmatized, and the stigma is sanctioned through both social and legal processes. Such stigma negatively influences health and other material and social aspects of daily life for men who have sex with men (MSM). However, there is evidence that stigma at the interpersonal level can intersect with stigma that may be operating simultaneously at other levels. Few studies provide a comprehensive qualitative assessment of the multi-level sexual stigma derived from the direct narratives of men with same-gender sexual experience. To help fill this gap on sexual stigma, we qualitatively investigated (1) what was the range of sexual stigma manifestations, and (2) how sexual stigma manifestations were distributed across socioecological levels in a sample of Ghanaian MSM. From March to September 2020, we conducted eight focus group discussions (FGDs) with MSM about their experiences with stigma from Accra and Kumasi, Ghana. Data from the FGDs were subjected to qualitative content analysis. We identified a range of eight manifestations of sexual stigma: (1) gossiping and outing; (2) verbal abuse and intrusive questioning; (3) non-verbal judgmental gestures; (4) societal, cultural, and religious blaming and shaming; (5) physical abuse; (6) poor-quality services; (7) living in constant fear and stigma avoidance; and (8) internal ambivalence and guilt about sexual behavior. Sexual stigma manifestations were unevenly distributed across socioecological levels. Our findings are consistent with those of existing literature documenting that, across Africa, and particularly in Ghana, national laws and religious institutions continue to drive stigma against MSM. Fundamental anti-homosexual sentiments along with beliefs associating homosexuality with foreign cultures and immorality drive the stigmatization of MSM. Stigma experienced at all socioecological levels has been shown to impact both the mental and sexual health of MSM. Deeper analysis is needed to understand more of the lived stigma experiences of MSM to develop appropriate stigma-reduction interventions. Additionally, more community-level stigma research and interventions are needed that focus on the role of family and peers in stigma toward MSM in Ghana.

show abstract

“…This nding is consistent with prior studies in Malawi 16 and SSA. [13][14][15] Parents also desired privacy, even at the expense of withholding care for their children, which highlights the integral role that stigma and parents play in HIV care engagement for ALWH. ART nonadherence was driven by two processes: discouragement around life-long medications and negative community attitudes towards ARTs.…”

Section: Discussionmentioning

confidence: 99%

Stigma and Discrimination Faced by Adolescents Living with HIV and Experiencing Depression in Malawi

Faidas,

Stockton,

Mphonda

et al. 2024

Preprint

View full text Add to dashboard Cite

Background In Malawi, approximately 25% of adolescents living with HIV (ALWH) also suffer from depression. Not only is HIV stigma a major contributor to depression, but it also adversely impacts HIV care engagement. ALWH can experience HIV stigma as stereotyping, social exclusion, low social support, and abuse; and these experiences are associated with poor mental health. Despite recognition of the deleterious effects of HIV stigma, we have limited knowledge of how stigma is experienced by depressed ALWH. Guided by the Health Stigma and Discrimination Framework, we describe stigma faced by depressed ALWH in Malawi, and its implications for future interventions. Methods As part of a larger formative study to adapt a mental health counseling intervention, we conducted in-depth interviews, social support mapping sessions, and focus group discussions with 25 ALWH, 4 caregivers of ALWH, 3 HIV providers, and 5 participants and 5 staff of a prior mental health counseling intervention. After analyzing the stigma codes, we used the Health Stigma and Discrimination Framework to organize the data into four key domains: drivers, manifestations, outcomes, and health and social impacts. Results Major drivers of HIV stigma included fear of HIV transmission, negative effects of antiretroviral therapy (ART), association with death, inaccurate knowledge, and negative attitudes towards ALWH. The most common manifestations of HIV stigma were gossip, insults and mocking, and physical and social distancing. Decreased ART adherence and missed HIV appointments were commonly cited outcomes of HIV stigma. Broader health impacts of HIV stigma were notable for mental health comorbidities including depression, anxiety, substance use, and suicidality. Identified resilience strategies included support for HIV care engagement and psychosocial support from family and friends. Conclusions This study is the first to specifically describe the stigmatization process faced by depressed ALWH in Malawi. Notably, HIV stigma continues to disrupt HIV care and detrimentally impacts mental health during adolescent development. Further studies focused specifically on stigma are needed to better characterize this process and identify additional resilience factors. Investment in stigma-reduction interventions for ALWH is needed to avert poor mental health and HIV outcomes. Trial registration: NCT06173544

show abstract

Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa

Cited by 22 publications

References 82 publications

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana

Multi-level manifestations of sexual stigma among men with same-gender sexual experience in Ghana

Multi-level Manifestations of Sexual Stigma among Men with Same-Gender Sexual Experience in Ghana

Stigma and Discrimination Faced by Adolescents Living with HIV and Experiencing Depression in Malawi

Contact Info

Product

Resources

About