TY - JOUR
T1 - Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries
AU - Wiginton, John Mark
AU - Murray, Sarah M.
AU - Poku, Ohemaa
AU - Augustinavicius, Jura
AU - Jackman, Kevon Mark Phillip
AU - Kane, Jeremy C
AU - Billong, Serge C.
AU - Diouf, Daouda
AU - Ba, Ibrahima
AU - Mothopeng, Tampose
AU - Njindam, Iliassou Mfochive
AU - Turpin, Gnilane
AU - Tamoufe, Ubald
AU - Sithole, Bhekie
AU - Zlotorzynska, Maria
AU - Sanchez, Travis H.
AU - Baral, Stefan D.
N1 - Funding Information:
Experiences of sexual behavior stigma among MSM in healthcare contexts have often been linked to disclosure of engagement in same-sex practices to HCWs [, –]. The relationship between healthcare stigma and disclosure of same-sex practices to family has been less researched, perhaps due to the more indirect, complex pathways between the two. Scholarship has linked family disclosure to difficulties accessing health services for MSM in SSA [], possibly reflecting the loss of social and financial support from family following disclosure, which may explain why disclosure by MSM to family has also been linked to economic independence [, ]. Alternatively, the link between family disclosure and difficulties accessing healthcare could be due to perceived or anticipated healthcare stigma stemming from family disclosure experiences. That is, negative reactions from family following disclosure may prime MSM to anticipate or perceive similar reactions from HCWs, avoiding disclosure to HCWs or avoiding healthcare encounters altogether [, ]. Positive reactions from family following disclosure could also lead to healthcare stigma. MSM who feel validated and supported by their family may be less concerned with concealing their sexuality in other contexts, proudly disclosing their same-sex practices to HCWs or displaying gender nonconforming mannerisms that may be perceived as homosexual, incurring enacted stigma as a result [, ]. While non-disclosure could perhaps be protective against some of the impacts of sexual behavior stigma [–], it could also preclude MSM from reaping disclosure’s benefits. Research has repeatedly established links between disclosure of same-sex practices by MSM to HCWs and receipt or utilization of appropriate HIV care and other sexual health services [–]. Similarly, disclosure to family may yield acceptance and affirmative social support, facilitate disclosure to HCWs, promote engagement in sexual health services, and support the adoption of positive health behaviors [, –].
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Disclosure
KW - Healthcare stigma
KW - Men who have sex with men
KW - Sub-Saharan Africa
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U2 - 10.1186/s12889-021-12151-3
DO - 10.1186/s12889-021-12151-3
M3 - Article
C2 - 34861835
AN - SCOPUS:85120751425
SN - 1471-2458
VL - 21
JO - BMC public health
JF - BMC public health
IS - 1
M1 - 2206
ER -