Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT 06510, USA.
Priorities on Rights and Sexual Health, Accra 00233, Ghana.
Int J Environ Res Public Health. 2021 Dec 12;18(24):13103. doi: 10.3390/ijerph182413103.
Men who have sex with men (MSM) in Ghana remain at heightened risk of HIV infection, and face challenges in accessing HIV prevention and care services. Previous research in Ghana shows that MSM face intersectional stigma across ecological levels (family, peers, healthcare settings, and community level) and the criminalization of same-gender sexual behaviors in the country. To protect their wellbeing from exposure to stigma, many MSM avoid interactions with healthcare systems and services, which inadvertently inhibits their opportunities for early detection and treatment of HIV. Consequently, MSM in Ghana carry a disproportionate burden of HIV prevalence (18%) compared to the general population (2%), highlighting the need for culturally relevant processes in HIV/STI prevention, and care communication to optimize sexual health and wellness among MSM in Ghana. To this effect, we collaborated with community partners to use the Assessment, Decision, Adaptation, Production, Topical Experts, Training, Testing (ADAPT-ITT) model to modify a theory-driven smartphone-based peer support intervention to enhance its focus on intersectional stigma reduction, and improve HIV health-seeking behaviors among MSM, including HIV testing and linkage to care. We used the Dennis Peer Support Model to develop the peer support components (emotional, informational, and appraisal support) to increase peer social support, decrease social isolation, and minimize intersectional stigma effects on HIV-related healthcare-seeking behaviors. This paper shows the preliminary acceptability and effectiveness of employing culturally relevant techniques and communication strategies to provide secure peer support to improve HIV prevention and care among key populations in highly stigmatized environments.
在加纳，男男性行为者（MSM）仍然面临着感染艾滋病病毒的高度风险，并且在获得艾滋病预防和护理服务方面面临挑战。加纳之前的研究表明，MSM 在生态层面（家庭、同龄人、医疗保健环境和社区层面）面临着交叉污名，而且同性性行为在加纳是违法的。为了保护他们的福祉免受污名的影响，许多 MSM 避免与医疗保健系统和服务互动，这无意中抑制了他们及早发现和治疗艾滋病毒的机会。因此，加纳的 MSM 承担着不成比例的 HIV 流行率（18%），而普通人群（2%），这突显了在 HIV/性传播感染预防和护理沟通中需要采用文化相关的过程，以优化加纳 MSM 的性健康和福祉。为此，我们与社区合作伙伴合作，使用评估、决策、适应、制作、主题专家、培训、测试（ADAPT-ITT）模型来修改基于智能手机的理论驱动的同伴支持干预措施，以增强其对交叉污名减少的关注，并改善 MSM 的 HIV 健康寻求行为，包括 HIV 检测和护理衔接。我们使用丹尼斯同伴支持模型来开发同伴支持组件（情感、信息和评估支持），以增加同伴社会支持，减少社会孤立，并最大限度地减少交叉污名对与 HIV 相关的医疗保健寻求行为的影响。本文展示了在高度污名化环境中为关键人群提供安全的同伴支持以改善 HIV 预防和护理的采用文化相关技术和沟通策略的初步可接受性和有效性。
