title: "If You Tell People That You Had Sex with a Fellow Man, It Is Hard to Be Helped and Treated": Barriers and Opportunities for Increasing Access to HIV Services among Men Who Have Sex with Men in Uganda.
abstract: BACKGROUND
  Despite the high HIV prevalence among men who have sex with men (MSM) in sub-Saharan Africa, little is known about their access to HIV services. This study assessed barriers and opportunities for expanding access to HIV services among MSM in Uganda.
  
  
  METHODS
  In October-December 2013, a cross-sectional qualitative study was conducted in 12 districts of Uganda. Semi-structured in-depth interviews were conducted with 85 self-identified MSM by snowball sampling and 61 key informants including HIV service providers and policy makers. Data were analysed using manifest content analysis and Atlas.ti software.
  
  
  RESULTS
  Three quarters of the MSM (n = 62, 72.9%) were not comfortable disclosing their sexual orientation to providers and 69 (81.1%) felt providers did not respect MSM. Half (n = 44, 51.8%) experienced difficulties in accessing health services. Nine major barriers to access were identified, including: (i) unwelcoming provider behaviours; (ii) limited provider skills and knowledge; (iii) negative community perceptions towards MSM; (iv) fear of being exposed as MSM; (v) limited access to MSM-specific services; (vi) high mobility of MSM, (vii) lack of guidelines on MSM health services; viii) a harsh legal environment; and ix) HIV related stigma. Two-thirds (n = 56, 66%) participated in MSM social networks and 86% of these (48) received support from the networks to overcome barriers to accessing services.
  
  
  CONCLUSIONS
  Negative perceptions among providers and the community present barriers to service access among MSM. Guidelines, provider skills building and use of social networks for mobilization and service delivery could expand access to HIV services among MSM in Uganda.
authors.affiliation: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Rhoda K
authors.initials: RK
authors.lastname: Wanyenze
authors.affiliation: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Geofrey
authors.initials: G
authors.lastname: Musinguzi
authors.affiliation: Department of Community Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Joseph K B
authors.initials: JK
authors.lastname: Matovu
authors.affiliation: Department of Community Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Juliet
authors.initials: J
authors.lastname: Kiguli
authors.affiliation: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Nuwaha
authors.affiliation: MARPS Network, Kampala, Uganda.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mujisha
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Joshua
authors.initials: J
authors.lastname: Musinguzi
authors.affiliation: Ministry of Health, Kampala, Uganda.
authors.forename: Jim
authors.initials: J
authors.lastname: Arinaitwe
authors.affiliation: RAND Corporation, Santa Monica, CA, United States of America.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D057545:Social Stigma; D014454:Uganda; D055815:Young Adult