Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana.
Behavioral, Sexual, and Global Health Lab, Jama'a Action, West Legon, Accra, Ghana; Behavioral, Sexual, and Global Health Lab, School of Nursing, University of Rochester, Rochester, NY, USA; School of Nursing, University of Rochester, Rochester, NY, USA; Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, USA.
Health Place. 2023 Sep;83:103076. doi: 10.1016/j.healthplace.2023.103076. Epub 2023 Jul 7.
Gays, bisexuals, and all other men who have sex with men (GBMSM) are heavily impacted by HIV in Ghana compared to the general population. In addition to HIV and same-sex intercourse stigma, barriers such as reduced privacy, lower-income status and limited health care facilities (HCF) affect HIV testing decisions among GBMSM. We employed a phenomenological research design to understand the role of place and stigma in HIV testing among GBMSM in slums. GBMSM (n = 12) from slums in Accra and Kumasi, Ghana, were recruited and engaged in face-to-face interviews. We used a multiple reviewer summative content analysis to analyze and organize our key findings. The HIV testing options we identified include 1. Government HCF, 2. NGO and community outreach 3. Peer-educated services. Factors influencing GBMSM to test for HIV at HCF outside their areas included 1. The location of HCF 2. HIV and sexual stigma from slum areas 3. Positive HCW attitudes at distant HCF. 4. Negative Healthcare worker (HCW) attitudes towards GBMSM. These findings highlighted how stigma from slums and HCW influence HIV testing decisions and the need for place-based interventions to address stigma among HCW in slums to improve testing among GBMSM.
男同性恋者、双性恋者和所有其他与男性发生性关系的男性(GBMSM)在加纳受到的 HIV 影响比一般人群更为严重。除了 HIV 和同性性行为的耻辱感外,隐私减少、收入水平较低和有限的医疗保健设施等障碍也会影响 GBMSM 的 HIV 检测决定。我们采用了现象学研究设计,以了解在加纳的贫民窟中,地点和耻辱感在 GBMSM 的 HIV 检测中的作用。我们招募了来自加纳阿克拉和库马西贫民窟的 12 名 GBMSM 进行面对面访谈。我们使用了多次评论者总结性内容分析来分析和组织我们的主要发现。我们确定的 HIV 检测选项包括 1. 政府 HCF、2. NGO 和社区外展、3. 同伴教育服务。影响 GBMSM 在远离其所在地区的 HCF 进行 HIV 检测的因素包括 1. HCF 的位置、2. 来自贫民窟地区的 HIV 和性耻辱感、3. 遥远的 HCF 中对 HCW 的积极态度、4. 对 GBMSM 的 HCW 持消极态度。这些发现强调了贫民窟和 HCW 的耻辱感如何影响 HIV 检测决策,以及需要针对贫民窟中的 HCW 开展基于地点的干预措施,以减少耻辱感,从而提高 GBMSM 的检测率。