title: Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana.
abstract: Same-sex practices are stigmatized in much of sub-Saharan Africa. Cross-sectional relationships between discrimination, access to and use of health care services, and HIV knowledge among men who have sex with men (MSM) were assessed in Malawi, Namibia, and Botswana. A survey and HIV screening were used to explore these variables and the prevalence of HIV. Overall, 19% of men screened positive for HIV infection. Ninety-three percent knew HIV is transmitted through anal sex with men, however, only 67% had ever received information of how to prevent this transmission. Few (17%) reported ever disclosing same sex practices to a health professional and 19% reported ever being afraid to seek health care. Men reported ever been denied health care services (5%) and 21% had ever been blackmailed because of their sexuality. Strong associations were observed between experiences of discrimination and fear of seeking health care services. Characterizing the relationship between stigma and health care seeking practices and attitudes can inform the development and implementation of HIV interventions for African MSM.
authors.affiliation: Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins School of Public Health, E7146, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Fay
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Baral
authors.forename: Gift
authors.initials: G
authors.lastname: Trapence
authors.forename: Felistus
authors.initials: F
authors.lastname: Motimedi
authors.forename: Eric
authors.initials: E
authors.lastname: Umar
authors.forename: Scholastika
authors.initials: S
authors.lastname: Iipinge
authors.forename: Friedel
authors.initials: F
authors.lastname: Dausab
authors.forename: Andrea
authors.initials: A
authors.lastname: Wirtz
authors.forename: Chris
authors.initials: C
authors.lastname: Beyrer
mesh_terms: D000328:Adult; D001902:Botswana / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004192:Discrimination, Psychological; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D015497:HIV-1; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009276:Namibia / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012747:Sexual Partners; D012959:Socioeconomic Factors; D013240:Stereotyping; D011795:Surveys and Questionnaires