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Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland

INTRODUCTION: Same-sex practices and orientation are both stigmatized and criminalized in many countries across sub-Saharan Africa. This study aimed to assess the relationship of fear of seeking healthcare and disclosure of same-sex practices among a sample of men who have sex with men (MSM) in Swaz...

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Autores principales: Risher, Kathryn, Adams, Darrin, Sithole, Bhekie, Ketende, Sosthenes, Kennedy, Caitlin, Mnisi, Zandile, Mabusa, Xolile, Baral, Stefan D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833105/
https://www.ncbi.nlm.nih.gov/pubmed/24242263
http://dx.doi.org/10.7448/IAS.16.3.18715
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author Risher, Kathryn
Adams, Darrin
Sithole, Bhekie
Ketende, Sosthenes
Kennedy, Caitlin
Mnisi, Zandile
Mabusa, Xolile
Baral, Stefan D
author_facet Risher, Kathryn
Adams, Darrin
Sithole, Bhekie
Ketende, Sosthenes
Kennedy, Caitlin
Mnisi, Zandile
Mabusa, Xolile
Baral, Stefan D
author_sort Risher, Kathryn
collection PubMed
description INTRODUCTION: Same-sex practices and orientation are both stigmatized and criminalized in many countries across sub-Saharan Africa. This study aimed to assess the relationship of fear of seeking healthcare and disclosure of same-sex practices among a sample of men who have sex with men (MSM) in Swaziland with demographic, socio-economic and behavioural determinants. METHODS: Three hundred and twenty-three men who reported having had anal sex with a man in the past year were recruited using respondent-driven sampling and administered a structured survey instrument. Asymptotically unbiased estimates of prevalence of stigma and human rights abuses generated using the RDSII estimator are reported with bootstrapped confidence intervals (CIs). Weighted simple and multiple logistic regressions of fear of seeking healthcare and disclosure of same-sex practices to a healthcare provider with demographic, social and behavioural variables are reported. RESULTS: Stigma was common, including 61.7% (95% CI=54.0–69.0%) reporting fear of seeking healthcare, 44.1% (95% CI=36.2–51.3%) any enacted stigma and 73.9% (95% CI=67.7–80.1%) any perceived social stigma (family, friends). Ever disclosing sexual practices with other men to healthcare providers was low (25.6%, 95% CI=19.2–32.1%). In multiple logistic regression, fear of seeking healthcare was significantly associated with: having experienced legal discrimination as a result of sexual orientation or practice (aOR=1.9, 95% CI=1.1–3.4), having felt like you wanted to end your life (aOR=2.0, 95% CI=1.2–3.4), having been raped (aOR=11.0, 95% CI=1.4–84.4), finding it very difficult to insist on condom use when a male partner does not want to use a condom (aOR=2.1, 95% CI=1.0–4.1) and having a non-Swazi nationality at birth (aOR=0.18, 95% CI=0.05–0.68). In multiple logistic regression, disclosure of same-sex practices to a healthcare provider was significantly associated with: having completed secondary education or more (aOR=5.1, 95% CI=2.5–10.3), having used a condom with last casual male sexual partner (aOR=2.4, 95% CI=1.0–5.7) and having felt like you wanted to end your life (aOR=2.1, 95% CI=1.2–3.8). CONCLUSIONS: MSM in Swaziland report high levels of stigma and discrimination. The observed associations can inform structural interventions to increase healthcare seeking and disclosure of sexual practices to healthcare workers, facilitating enhanced behavioural and biomedical HIV-prevention approaches among MSM in Swaziland.
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spelling pubmed-38331052013-11-19 Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland Risher, Kathryn Adams, Darrin Sithole, Bhekie Ketende, Sosthenes Kennedy, Caitlin Mnisi, Zandile Mabusa, Xolile Baral, Stefan D J Int AIDS Soc Global action to reduce HIV stigma and discrimination INTRODUCTION: Same-sex practices and orientation are both stigmatized and criminalized in many countries across sub-Saharan Africa. This study aimed to assess the relationship of fear of seeking healthcare and disclosure of same-sex practices among a sample of men who have sex with men (MSM) in Swaziland with demographic, socio-economic and behavioural determinants. METHODS: Three hundred and twenty-three men who reported having had anal sex with a man in the past year were recruited using respondent-driven sampling and administered a structured survey instrument. Asymptotically unbiased estimates of prevalence of stigma and human rights abuses generated using the RDSII estimator are reported with bootstrapped confidence intervals (CIs). Weighted simple and multiple logistic regressions of fear of seeking healthcare and disclosure of same-sex practices to a healthcare provider with demographic, social and behavioural variables are reported. RESULTS: Stigma was common, including 61.7% (95% CI=54.0–69.0%) reporting fear of seeking healthcare, 44.1% (95% CI=36.2–51.3%) any enacted stigma and 73.9% (95% CI=67.7–80.1%) any perceived social stigma (family, friends). Ever disclosing sexual practices with other men to healthcare providers was low (25.6%, 95% CI=19.2–32.1%). In multiple logistic regression, fear of seeking healthcare was significantly associated with: having experienced legal discrimination as a result of sexual orientation or practice (aOR=1.9, 95% CI=1.1–3.4), having felt like you wanted to end your life (aOR=2.0, 95% CI=1.2–3.4), having been raped (aOR=11.0, 95% CI=1.4–84.4), finding it very difficult to insist on condom use when a male partner does not want to use a condom (aOR=2.1, 95% CI=1.0–4.1) and having a non-Swazi nationality at birth (aOR=0.18, 95% CI=0.05–0.68). In multiple logistic regression, disclosure of same-sex practices to a healthcare provider was significantly associated with: having completed secondary education or more (aOR=5.1, 95% CI=2.5–10.3), having used a condom with last casual male sexual partner (aOR=2.4, 95% CI=1.0–5.7) and having felt like you wanted to end your life (aOR=2.1, 95% CI=1.2–3.8). CONCLUSIONS: MSM in Swaziland report high levels of stigma and discrimination. The observed associations can inform structural interventions to increase healthcare seeking and disclosure of sexual practices to healthcare workers, facilitating enhanced behavioural and biomedical HIV-prevention approaches among MSM in Swaziland. International AIDS Society 2013-11-13 /pmc/articles/PMC3833105/ /pubmed/24242263 http://dx.doi.org/10.7448/IAS.16.3.18715 Text en © 2013 Risher K et al; licensee International AIDS Society http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Global action to reduce HIV stigma and discrimination
Risher, Kathryn
Adams, Darrin
Sithole, Bhekie
Ketende, Sosthenes
Kennedy, Caitlin
Mnisi, Zandile
Mabusa, Xolile
Baral, Stefan D
Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
title Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
title_full Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
title_fullStr Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
title_full_unstemmed Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
title_short Sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
title_sort sexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in swaziland
topic Global action to reduce HIV stigma and discrimination
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833105/
https://www.ncbi.nlm.nih.gov/pubmed/24242263
http://dx.doi.org/10.7448/IAS.16.3.18715
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