Amsterdam 2015
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| Abstract #2147 - Cape to Casablanca: MSM in Africa | ||||
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Session: 20.8: Cape to Casablanca: MSM in Africa (Parallel) on Wednesday @ 16.30-18.00 in C104 Chaired by Theo Sandfort, Mike Ross Authors: Presenting Author: Mr Markus Larsson - Lund Univeristy, Sweden |
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| Additional Authors: | ||||
| Aim: The aim of the study was to explore how stigma affects healthcare access and help-seeking behaviour among men who have sex with men (MSM) in Tanzania. | ||||
| Method / Issue: Homosexuality is illegal in Tanzania and stigma of same-sex sexual behaviours has been reported to be high, also in the healthcare sector. At the same time, data reveal that men who have sex with men (MSM) has a disproportional burden of HIV. However, our understanding is limited of how MSM cope with stigma in healthcare and how it interferes with their help-seeking strategies in an African setting. This study was nested within a cross-sectional study of 200 MSM in Dar es Salaam, Tanzania, conducted in 2012, using Respondent Driven Sampling. Every 10th respondent, who agreed to be interviewed about experiences of stigma in healthcare participated in a qualitative study. After -outs, the final sample included 12 persons. Data was interpreted using Qualitative Content Analysis. | ||||
| Results / Comments: Common themes included experiences of discrimination in public healthcare. The men experienced scolding, invasive questioning of their sexuality and outright denial of treatment when healthcare workers (HCWs) discovered that they were MSM. This created fears of becoming stigmatised in healthcare situations. As result, the men had developed various strategies to cope with situations associated with becoming stigmatised. Those men who could afford private healthcare services opted for these, as they were perceived as less discriminatory. The monetary fee was seen as a guarantee for not becoming stigmatised, which facilitated access, as the men were less concerned about concealing their sexual identity. When private healthcare services not were affordable the men resorted to strategies that attempted to hide their sexual identity during the interaction with the public HCWs. These included enacting to perceived masculinity norms or controlling/manipulating information about their symptoms or sexual history. By keeping their homosexual or MSM status invisible to the HCWs they managed to access treatment and services. The men also engaged in self-treatment with drugs obtained from pharmacies, in particular when suffering from a STI that potentially could reveal their sexual identity. Some of the men had resigned to the pressure of becoming stigmatised and avoided healthcare completely. | ||||
| Discussion: Experiences of stigma related to homosexuality prevent MSM from timely and adequate HIV services. Our findings indicate that there is limited understanding of same-sex sexuality among Tanzanian HCWs. Specialised training for HCWs that addresses homosexuality and same-sex sexual relations as integral parts of the broader human sexuality could fill an important role in demystifying and uncovering persistent myths and misconceptions about same-sex sexuality. Our findings further demonstrate that service utilisation is low and infrequent among MSM due to fear of becoming stigmatised. This indicates that self-stigma has an important role in inhibiting health-seeking behaviours. By linking sensitised service providers to existing MSM networks, dissemination about available services that are safe could be facilitated. This could lower barriers for HIV and STI testing and expand treatment services for those in need. | ||||
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