In Sub Saharan Africa, prevalence for HIV amongst men who have sex with men (MSM) is higher than other groups, in Kenya for instance, it is almost three times as high compared to the general population. There is a stigma associated with being HIV positive, in MSM who are HIV+, this stigma may be layered – as they deal with stigma for both their HIV status and for being a man who has sex with men. This layered stigma may further prevent MSM from accessing treatment and care services.
To further understand this, researchers from the Brown University School of Public Health conducted a survey amongst men who had sex with men in Elodret, Kenya. Led by Ms. Sylvia Shangani, a doctoral candidate in the department of behavioural and social sciences, under the supervision of Dr. Don Operario, they found that amongst MSM, there were perceptions that healthcare providers were not knowledgable enough to offer treatment for MSM and MSM were frequently the recipients of discrimination and stigmatizing attitudes from healthcare providers.
Eighty nine men participated in the survey and included men who identified as homosexual, bisexual and heterosexual. Questions were asked about internalized stigma, enacted stigma, as well as mistrust of healthcare providers. Men who identified as homosexual reported higher levels of enacted stigma than other men. They also reported greater mistrust of healthcare providers than other groups. When it came to mistrust of healthcare providers, participants noted that healthcare providers could be judgemental and express stigmatizing attitudes. Participants also reported that they preferred younger providers to older ones as younger ones tended to be friendlier.
Issues ranged beyond overt discrimination; participants also noted that healthcare providers were not always equipped with the knowledge and skills necessary to provide treatment for HIV, sexually transmitted infections (STIs) and other issues related to sexual health. Participants also complained that HIV prevention outreach and materials were targeted mainly towards heterosexual people.
This study demonstrated the need to reduce stigma from healthcare providers and to increase their knowledge and competency to provide care to MSM, as part of HIV prevention efforts.