“但一旦他们发现你是男男性行为者……”：对加纳医疗系统中男男性行为者（MSM）的艾滋病毒预防经历的定性调查。
"But the moment they find out that you are MSM…": a qualitative investigation of HIV prevention experiences among men who have sex with men (MSM) in Ghana's health care system.
作者信息
Kushwaha Sameer, Lalani Yasmin, Maina Geoffrey, Ogunbajo Adedotun, Wilton Leo, Agyarko-Poku Thomas, Adu-Sarkodie Yaw, Boakye Francis, Zhang Nanhua, Nelson LaRon E
机构信息
University of Toronto, Toronto, ON, Canada.
University of Rochester, Rochester, NY, USA.
出版信息
BMC Public Health. 2017 Oct 3;17(1):770. doi: 10.1186/s12889-017-4799-1.
BACKGROUND
The prevalence of HIV in Ghana is 1.3%, compared to 17% among men who have sex with men (MSM). There is limited empirical data on the current health care climate and its impact on HIV prevention services for Ghanaian MSM. The purposes of this study were to investigate (1) MSM's experiences using HIV prevention resources, (2) what factors, including health care climate factors, influenced MSM's use of prevention resources and (3) MSM self-identified strategies for improving HIV/sexually transmitted infection (STI) prevention among MSM in Ghanaian communities.
METHODS
We conducted 22 focus groups (n = 137) with peer social networks of MSM drawn from three geographic communities in Ghana (Accra, Kumasi, Manya Krobo). The data were examined using qualitative content analysis. Interviews with individual health care providers were also conducted to supplement the analysis of focus group findings to provide more nuanced illuminations of the experiences reported by MSM.
RESULTS
There were four major findings related to MSM experiences using HIV prevention resources: (1) condom quality is low, condom access is poor, and condom use is disruptive, (2) inaccurate information undermines HIV testing (3), stigma undermines HIV testing, and (4) positive attitudes towards HIV prevention exist among MSM. The main healthcare climate factors that affected prevention were that MSM were not free to be themselves, MSM were not understood by healthcare providers, and that MSM did not feel that healthcare providers cared about them. To improve HIV prevention MSM suggested increased education tailored to MSM should be provided to enable self-advocacy and that education and awareness are needed to protect human rights of MSM in Ghana.
CONCLUSION
MSM in Ghana are exposed to negative health care climates. Health care spaces that are unsupportive of MSM's autonomy undermine the uptake of prevention measures such as condoms, HIV testing, and accurate sexual health education. These findings contribute to knowledge to inform development of HIV prevention interventions for MSM in Ghana, such as culturally appropriate sexual health education, and digital technology to connect individuals with resources supportive of MSM.
背景
加纳的艾滋病毒感染率为1.3%，而男男性行为者（MSM）中的感染率为17%。关于加纳当前的医疗保健环境及其对男男性行为者艾滋病毒预防服务的影响，实证数据有限。本研究的目的是调查：（1）男男性行为者使用艾滋病毒预防资源的经历；（2）包括医疗保健环境因素在内的哪些因素影响了男男性行为者对预防资源的使用；（3）男男性行为者自我认同的改善加纳社区男男性行为者艾滋病毒/性传播感染（STI）预防的策略。
方法
我们与来自加纳三个地理社区（阿克拉、库马西、马尼亚克罗博）的男男性行为者同伴社交网络进行了22次焦点小组访谈（n = 137）。使用定性内容分析法对数据进行了分析。还对个体医疗保健提供者进行了访谈，以补充焦点小组调查结果的分析，从而更细致入微地阐明男男性行为者报告的经历。
结果
与男男性行为者使用艾滋病毒预防资源的经历相关的有四项主要发现：（1）避孕套质量低、获取困难且使用不便；（2）不准确的信息妨碍艾滋病毒检测；（3）耻辱感妨碍艾滋病毒检测；（4）男男性行为者对艾滋病毒预防持积极态度。影响预防的主要医疗保健环境因素是男男性行为者无法自由展现自我、医疗保健提供者不理解男男性行为者，以及男男性行为者感觉医疗保健提供者不关心他们。为改善艾滋病毒预防，男男性行为者建议应提供针对男男性行为者的更多教育，以促进自我倡导，并且需要开展教育和提高认识活动以保护加纳男男性行为者的人权。
结论
加纳的男男性行为者面临负面的医疗保健环境。不支持男男性行为者自主性的医疗保健场所会妨碍避孕套、艾滋病毒检测及准确的性健康教育等预防措施的采用。这些发现有助于为加纳男男性行为者制定艾滋病毒预防干预措施提供知识参考，例如开展符合文化特点的性健康教育，以及利用数字技术将个人与支持男男性行为者的资源联系起来。
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