Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI, 48824, USA.
MPact Global Action for Gay Men's Health and Rights, 111 Broadway, Floor 3, Oakland, CA, 94607, USA.
AIDS Behav. 2021 Aug;25(8):2551-2567. doi: 10.1007/s10461-021-03216-w. Epub 2021 Mar 17.
Despite the prevailing consensus on the role that stigma and discrimination play in limiting access to HIV prevention technology, discouraging HIV testing, and impeding access to HIV care, studies that focus on structural interventions to address stigma and discrimination for gay, bisexual, and other men who have sex with men and transgender women are surprisingly uncommon. We aimed to identify the outcomes from a coordinated set of community-led advocacy initiatives targeting structural changes that might eliminate barriers to HIV care for gay and bisexual men and transgender women in five African and two Caribbean countries. We conducted a prospective evaluation that included repeated site visits and in-depth semi-structured interviews with 112 people with direct knowledge of project activities, accomplishments, failures, and challenges. Using outcome harvesting and qualitative analysis methods, we observed that over the 18-month implementation period, local advocacy efforts contributed to enhanced political will on the part of duty bearers for ensuring equitable access to HIV care, increases in the availability of affirming resources, improved access to existing resources, and changes in normative institutional practices to enable access to HIV care. Evidence on Project ACT points to the vital role community-led advocacy plays in addressing stigma and discrimination as structural barriers to HIV care.
尽管人们普遍认为污名和歧视在限制获得艾滋病毒预防技术、阻碍艾滋病毒检测以及妨碍获得艾滋病毒护理方面发挥了作用，但关注针对男同性恋者、双性恋者和其他与男性发生性关系的男性以及跨性别女性的结构性干预措施以解决污名和歧视的研究却出奇地少见。我们旨在确定一整套协调的社区主导的倡导举措的结果，这些举措旨在针对结构性变革，以消除艾滋病毒护理方面对非洲五个国家和加勒比两个国家的男同性恋者和双性恋者以及跨性别女性的障碍。我们进行了一项前瞻性评估，包括对 112 名直接了解项目活动、成就、失败和挑战的人进行了多次现场访问和深入的半结构化访谈。使用成果收集和定性分析方法，我们观察到，在 18 个月的实施期间，当地的倡导努力有助于增强责任承担者确保公平获得艾滋病毒护理的政治意愿，增加了肯定性资源的供应，改善了现有资源的获取，并改变了规范的机构做法，以实现艾滋病毒护理的获取。“行动项目”的证据表明，社区主导的倡导在解决艾滋病毒护理方面的污名和歧视等结构性障碍方面发挥了至关重要的作用。
