“我们不是同性恋……别跟我说那些事”：在缅甸，让“隐藏”的男男性行为者和跨性别女性参与艾滋病预防。
"We are not gays… don't tell me those things": engaging 'hidden' men who have sex with men and transgender women in HIV prevention in Myanmar.
机构信息
Disease Elimination Program, Burnet Institute, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
出版信息
BMC Public Health. 2019 Jan 14;19(1):63. doi: 10.1186/s12889-018-6351-3.
BACKGROUND
In Myanmar, HIV is concentrated among key populations, yet less than half of the estimated 250,000 men who have sex with men (MSM) and transgender women (TW) report recent HIV testing. As many as 50% of MSM and TW may conceal their same-sex preferences and behaviors, yet little is known about the barriers faced by those who are locally regarded as 'hidden' - that is, MSM who do not disclose same-sex preferences and/or identify as gay. This study explored specific barriers to accessing HIV testing and other prevention services among 'hidden' MSM to inform appropriate models of service delivery.
METHODS
In-depth interviews with MSM (n = 12) and TW (n = 13) and focus group discussions (FGD) with MSM and TW community members, leaders and key informants (n = 35) were undertaken in Yangon during June - September 2015. Participants were recruited by word-of-mouth by trained peer data collectors. Responses to questions from semi-structured guides were transcribed and coded using Atlas Ti. Codes were based on key domains in the guides and applied to transcripts to identify and analyze emerging themes.
RESULTS
Fear of stigma and discrimination and the need to meet gender expectations were key reasons for non-disclosure of same-sex preferences and behaviors; this typically manifested as avoidance of other MSM and settings in which sexual identity might be implicated. These concerns influenced preference and interaction with HIV services, with many avoiding MSM-specific services or eschewing HIV testing services entirely. The difficulties of engaging hidden MSM in HIV prevention was strongly corroborated by service providers.
CONCLUSION
Hidden MSM face multiple barriers to HIV testing and prevention. Strategies cognizant of concerns for anonymity and privacy, such as One-Stop Shop services and online-based health promotion, can discretely provide services appropriate for hidden MSM. Enhanced capacity of peer-service providers and mainstream health staff to identify and respond to the psychosocial challenges reported by hidden MSM in this study may further encourage service engagement. Overarching strategies to strengthen the enabling environment, such as legal reform and LGBTI community mobilisation, can lessen stigma and discrimination and increase hidden MSM's comfort and willingness to discuss same-sex behavior and access appropriate services.
背景
在缅甸，艾滋病毒主要集中在重点人群中，但估计有 25 万名男男性行为者（MSM）和跨性别女性（TW）中，仅有不到一半人报告最近进行了艾滋病毒检测。多达 50%的 MSM 和 TW 可能隐瞒他们的同性偏好和行为，但对于那些被当地视为“隐藏”的人，即不公开同性偏好和/或自认为同性恋的 MSM，人们知之甚少。本研究探讨了“隐藏”的 MSM 获得艾滋病毒检测和其他预防服务的具体障碍，以为提供适当的服务模式提供信息。
方法
2015 年 6 月至 9 月期间，在仰光对 MSM（n=12）和 TW（n=13）进行了深入访谈，并对 MSM 和 TW 社区成员、领导人以及关键信息提供者（n=35）进行了焦点小组讨论。参与者是由经过培训的同伴数据收集员通过口碑招募的。从半结构化指南中提出的问题的回答被转录并使用 Atlas Ti 进行编码。代码基于指南中的关键领域，并应用于转录本，以识别和分析新出现的主题。
结果
对污名化和歧视的恐惧以及满足性别期望的需要是不公开同性偏好和行为的主要原因；这通常表现为避免其他 MSM 和可能涉及性身份的环境。这些担忧影响了对艾滋病毒服务的偏好和互动，许多人避免使用 MSM 特定服务或完全避免艾滋病毒检测服务。服务提供者强烈证实了难以让隐藏的 MSM 参与艾滋病毒预防工作。
结论
隐藏的 MSM 在艾滋病毒检测和预防方面面临多种障碍。意识到匿名和隐私问题的策略，例如一站式服务和基于在线的健康促进，可以谨慎地为隐藏的 MSM 提供适当的服务。增强同伴服务提供者和主流卫生工作人员识别和应对本研究中隐藏的 MSM 报告的心理社会挑战的能力，可以进一步鼓励服务参与。加强有利环境的总体战略，例如法律改革和男女同性恋、双性恋、跨性别和无性恋者社区动员，可以减少污名化和歧视，增加隐藏的 MSM 对讨论同性行为和获得适当服务的舒适感和意愿。
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