title: Influence of stigma and homophobia on mental health and on the uptake of HIV/sexually transmissible infection services for Cameroonian men who have sex with men.
abstract: Background Men who have sex with men (MSM) in Cameroon consistently face significant stigma and discrimination. The urban HIV prevalence in MSM is estimated at 35%. This study investigates the effect of stigma, discrimination and alienation on Cameroonian MSM's engagement of the HIV treatment cascade.
  
  
  METHODS
  Qualitative interviews were semi-structured using a guide. Participants in Douala, Ngaoundere, Bamenda, Bertoua and Yaoundé were asked to describe the MSM social and structural context, MSM knowledge of existing HIV-related services in public and MSM-focussed non-governmental organisation (NGO) clinics. Using a codebook, coded text was extracted from 40 transcripts with Microsoft Word Macros. These texts were analysed for recurring themes that were developed into results.
  
  
  RESULTS
  There were three main themes that emerged. First, among those MSM participants seeking HIV services, many commonly reported experiences of discrimination and physical violence outside the healthcare setting. Second, a few respondents used services provided by the Ministry of Health and local NGOs. However, most participants observed limited clinical and cultural competency of public clinic staff. Third, MSM declared that lack of social support and healthcare access caused them much stress. Several individuals recounted their alienation greatly discouraged them from seeking HIV prevention, treatment and care services.
  
  
  CONCLUSIONS
  Community-level and public healthcare-related stigma impacts the mental wellbeing of Cameroonian MSM. Alienation among MSM also represents a common obstacle to the uptake of MSM-oriented HIV/AIDS services. Improving provider cultural and clinical competency among Cameroonian health care workers combined with a broader stigma-reduction intervention for Cameroonian healthcare may increase the uptake of HIV prevention, treatment and care among MSM.
authors.affiliation: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Cange
authors.affiliation: Global Viral Cameroon, Yaoundé, Cameroon.
authors.forename: Matthew
authors.initials: M
authors.lastname: LeBreton
authors.affiliation: Comité national de lutte contre le sida (CNLS), Ministère de la Santé Publique (MINSANTE), Face Fondation Chantal BIYA, BP 1459 Yaoundé, Cameroon.
authors.forename: Serge
authors.initials: S
authors.lastname: Billong
authors.affiliation: Global Viral, 1 Sutter St # 600 Metabiota, San Francisco, CA 94104, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Saylors
authors.affiliation: Global Viral Cameroon, Yaoundé, Cameroon.
authors.forename: Ubald
authors.initials: U
authors.lastname: Tamoufe
authors.affiliation: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Papworth
authors.affiliation: Alternatives-Cameroun, Douala, Cameroon.
authors.forename: Yves
authors.initials: Y
authors.lastname: Yomb
authors.affiliation: Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N. Wolfe Street, Baltimore, MD, 21205, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Baral