School of Public Health, University of Western Cape, Cape Town, South Africa.
Public Health Science Department, Institute of Health Sciences, Serowe, Botswana.
Glob Health Action. 2023 Dec 31;16(1):2262197. doi: 10.1080/16549716.2023.2262197. Epub 2023 Oct 13.
Men who have sex with men (MSM) represent an increasing number of new HIV infections in Botswana. Many in Botswana still hold discriminatory views against people who engage in same-sex practices. While it is well documented that stigma and discrimination undermine efforts to prevent HIV, the literature about the perception and experiences of discrimination against MSM in accessing HIV services in Botswana is scant.
OBJECTIVE(S): In this study, we sought to explore the perception and experiences of discrimination against MSM to improve access to HIV services and reduce discrimination against this marginalised population.
We employed a descriptive qualitative design using purposive sampling to recruit 20 MSM and 12 stakeholders (six policy-makers and six service providers) involved in implementing HIV/AIDS interventions in Botswana. We conducted semi-structured interviews with participants. All data were audio-recorded, transcribed, translated into English and analysed using thematic analysis.
The findings of this study show that MSM experience discrimination at the policy, healthcare system and community levels, which undermines their ability to seek HIV services. The participants reported that MSM are excluded from HIV policies and targeted HIV services. They reported a scarcity of trained personnel, poor access to HIV information, condoms, lack of treatment services targeted at MSM and negative attitudes directed towards MSM by service providers and other users. The participants also reported that they are excluded from community interventions and experience negative attitudes from community and family members.
Discrimination against MSM undermines the ability of HIV interventions to address MSM sexual health needs. The findings indicate the importance of enabling MSM to overcome discrimination to seek HIV services. Also, there is a need to further explore discrimination against MSM by service providers within the healthcare settings and ways to improve their understanding of male same-sex practices.
男男性行为者（MSM）在博茨瓦纳新感染艾滋病毒的人数不断增加。许多博茨瓦纳人仍然对从事同性性行为的人持有歧视性观点。虽然有大量文献记录表明耻辱感和歧视会破坏预防艾滋病毒的努力，但关于博茨瓦纳 MSM 在获得艾滋病毒服务方面受到歧视的看法和经历的文献却很少。
在这项研究中，我们试图探讨 MSM 受到歧视的看法和经历，以改善获得艾滋病毒服务的机会，并减少对这一边缘化人群的歧视。
我们采用描述性定性设计，通过目的性抽样招募了 20 名 MSM 和 12 名利益攸关方（6 名政策制定者和 6 名服务提供者），他们参与了在博茨瓦纳实施艾滋病毒/艾滋病干预措施。我们对参与者进行了半结构化访谈。所有数据均进行了录音、转录、翻译成英文，并使用主题分析进行分析。
这项研究的结果表明，MSM 在政策、医疗保健系统和社区层面上受到歧视，这削弱了他们寻求艾滋病毒服务的能力。参与者报告说，MSM 被排除在艾滋病毒政策和有针对性的艾滋病毒服务之外。他们报告说，缺乏受过培训的人员，难以获得艾滋病毒信息，缺乏针对 MSM 的治疗服务，服务提供者和其他使用者对 MSM 持负面态度。参与者还报告说，他们被排除在社区干预措施之外，受到社区和家庭成员的负面态度。
对 MSM 的歧视削弱了艾滋病毒干预措施满足 MSM 性健康需求的能力。研究结果表明，必须使 MSM 能够克服歧视，寻求艾滋病毒服务。此外，还需要进一步探讨医疗保健环境中服务提供者对 MSM 的歧视以及提高他们对男性同性性行为的理解的方法。
