Ulanja Mark B, Lyons Carrie, Ketende Sosthenes, Stahlman Shauna, Diouf Daouda, Kouamé Abo, Ezouatchi Rebecca, Bamba Amara, Drame Fatou, Liestman Ben, Baral Stefan
Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, E7146, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Enda Santé, Dakar, Senegal.
BMC Int Health Hum Rights. 2019 Mar 5;19(1):11. doi: 10.1186/s12914-019-0186-6.
In Cote D'Ivoire, there has been limited coverage of evidence-based sexual health services specifically supporting men who have sex with men (MSM). To date, there has been limited study of the determinants of engagement in these services including multiple intersecting stigmas and depression.
1301 MSM aged 18 years and older, were recruited using respondent-driven sampling in Abidjan, Yamoussoukro, Gagnoa and Bouake, Cote d'Ivoire from January 2015 to October 2015. Inclusion criteria included anal sex with another man in the past 12 months were to complete a structured questionnaire including the Patient Health Questionnaire (PHQ)-9 to screen for depression. Chi-Square tests were used to test difference in healthcare utilization across variables, and multiple logistic regression was used to test the association between depression and health care utilization represented by HIV and sexually transmittable infection testing and treatment.
Depression (aOR:1.40, 95% CI: 1.07-1.84), being aged 25-29 years (aOR:1.84, 95% CI: 1.11-3.03),unemployed (aOR:0.64, 95% CI: 0.42-0.98), being a student (aOR:0.67, 95% CI: 0.48-0.96), being identified as male (aOR:0.44, 95% CI: 0.29-0.67), and identifying as homosexual (aOR:0.74, 95% CI:0.56-0.99) were significantly associated with utilization of sexual health care services in the final multivariable model. Healthcare enacted stigma (aOR: 1.55, 95% CI: 1.03-2.33) was associated with utilizing sexual health care services, but perceived healthcare stigma, social stigma and family stigma were not.
Given higher levels of depressive symptomatology among those engaging in sexual health care services, this engagement represents an opportunity for service integration which may have synergistic benefits for both sexual and mental health. Moreover, MSM in Cote D'Ivoire who had engaged in sexual health services were more likely to report having experienced health-care enacted stigma. Taken together, these results reinforce the need for stigma mitigation interventions to support sustained engagement in HIV prevention, treatment and care services as a means of reducing health disparities among MSM in Cote d'Ivoire.
在科特迪瓦，专门为男男性行为者（MSM）提供的循证性健康服务覆盖范围有限。迄今为止，对参与这些服务的决定因素的研究有限，包括多种交叉的耻辱感和抑郁症。
2015年1月至2015年10月，在科特迪瓦的阿比让、亚穆苏克罗、加尼奥阿和布瓦凯，采用应答者驱动抽样方法招募了1301名18岁及以上的男男性行为者。纳入标准包括在过去12个月内与另一名男性发生肛交，并完成一份结构化问卷，包括患者健康问卷（PHQ）-9以筛查抑郁症。采用卡方检验来检验不同变量之间医疗保健利用情况的差异，并使用多因素逻辑回归来检验抑郁症与以艾滋病毒和性传播感染检测及治疗为代表的医疗保健利用之间的关联。
在最终的多变量模型中，抑郁症（调整后比值比：1.40，95%置信区间：1.07-1.84）、年龄在25-29岁之间（调整后比值比：1.84，95%置信区间：1.11-3.03）、失业（调整后比值比：0.64，95%置信区间：0.42-0.98）、是学生（调整后比值比：0.67，95%置信区间：0.48-0.96）、被认定为男性（调整后比值比：0.44，95%置信区间：0.29-0.67）以及被认定为同性恋（调整后比值比：0.74，9%置信区间：0.56-0.99）与性健康保健服务的利用显著相关。医疗造成的耻辱感（调整后比值比：1.55，95%置信区间：1.03-2.33）与性健康保健服务的利用相关，但感知到的医疗耻辱感、社会耻辱感和家庭耻辱感则不然。
鉴于参与性健康保健服务的人群中抑郁症状水平较高，这种参与为服务整合提供了一个机会，可能对性健康和心理健康都有协同益处。此外，在科特迪瓦参与性健康服务的男男性行为者更有可能报告经历过医疗造成的耻辱感。综上所述，这些结果强化了减轻耻辱感干预措施的必要性，以支持持续参与艾滋病毒预防、治疗和护理服务，作为减少科特迪瓦男男性行为者健康差距的一种手段。
