Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, USA.
Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Public Health. 2021 Dec 3;21(1):2206. doi: 10.1186/s12889-021-12151-3.
For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma.
We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d'Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data.
Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations.
Research to determine the factors driving disclosure's differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.
对于撒哈拉以南非洲（SSA）的男男性行为者（MSM）来说，向家人和医疗保健工作者（HCWs）披露同性性行为可以促进获得 HIV 预防服务和支持，但也可能导致污名化的经历。
我们对来自喀麦隆、塞内加尔、科特迪瓦、莱索托和斯威士兰的 MSM 的汇总数据进行了混合效应回归分析，以评估在医疗保健背景下披露与性行为污名之间的关联；我们使用逻辑回归分析了特定国家的数据。
与既未向家人也未向 HCWs 透露的参与者相比，仅向家人透露的参与者更有可能被 HCWs 八卦（aOR=1.70，CI=1.18，2.45）；向家人透露与在医疗中心受到虐待的可能性之间存在关联，但未达到统计学意义（aOR=1.56，CI=0.94，2.59）。仅向 HCWs 透露的参与者更有可能害怕寻求医疗服务（aOR=1.60，CI=1.14，2.25）、避免医疗服务（aOR=1.74，CI=1.22，2.50）和在医疗中心受到虐待（aOR=2.62，CI=1.43，4.81）。同时向家人和 HCWs 透露的参与者更有可能害怕寻求医疗服务（aOR=1.71，CI=1.16，2.52）、避免医疗服务（aOR=1.59，CI=1.04，2.42）、被 HCWs 八卦（aOR=3.78，CI=2.38，5.99）和在医疗中心受到虐待（aOR=3.39，CI=1.86，6.20）。特定国家的分析表明，来自喀麦隆的数据驱动了其中的一些关联。
需要研究确定在不同背景下披露对医疗保健污名的不同影响的驱动因素。最终，支持能够安全披露的环境对于了解 HIV 获得风险以及为 SSA 的 MSM 提供差异化的 HIV 预防、治疗和检测服务至关重要。
