HIV care engagement and ART adherence among Kenyan gay, bisexual, and other men who have sex with men: a multi-level model informed by qualitative research
HIV care engagement and ART adherence among Kenyan gay, bisexual, and other men who have sex with men: a multi-level model informed by qualitative research
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DOI：
10.1080/09540121.2018.1515471
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发表时间：
2018-08-23
影响因子：
1.7
通讯作者：
Simoni, Jane M.
中科院分区：
文献类型：
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作者：
Graham, Susan M.;Micheni, Murugi;Simoni, Jane M.
在撒哈拉以南非洲，同性恋、双性恋和其他男男性行为者（GBMSM）受到高度污名化，男男性行为往往被视为犯罪，阻碍了人们获得高质量的性健康、艾滋病毒预防和治疗服务。为了更好地了解艾滋病毒护理的参与和抗逆转录病毒治疗（ART）的坚持GBMSM在这种情况下，一个概念模型纳入社会文化因素是必要的。我们进行了一项定性研究的障碍和促进因素的艾滋病毒护理参与和ART坚持肯尼亚GBMSM，知情的概念模型的基础上的访问，信息，动机和行为技能（访问IMB）模型，在供应商的信任和耻辱和歧视作为先验因素的利益。我们进行了30个半结构化的采访，艾滋病毒阳性的肯尼亚GBMSM，其中20人正在接受抗逆转录病毒治疗，10人尚未开始治疗。演绎的方法被用来确认的相关性的基本概念的访问IMB模型，而归纳的方法被用来确定的内容，从男人的生活经验。艾滋病相关的信息，动机和行为技能似乎与艾滋病毒护理参与和ART依从性相关，在探索促进者和障碍的话语中始终出现污名化和歧视。值得信赖的提供者和支持的家人和朋友帮助了许多男性，与顺从相关的概念，如选择性地披露GBMSM状态，与女同性恋，男同性恋，双性恋和变性人（LGBT）组织的联系，自我接受，目标设定，社会认同和利他主义成为重要的促进因素。调查结果表明，需要增加肯尼亚GBMSM感染艾滋病毒的提供者和同行的支持。此外，他们指出了干预措施的潜在价值，这些干预措施提供了建立或增强社区归属感的机会，以改善艾滋病毒护理参与并促进这一弱势群体坚持抗逆转录病毒治疗。
Gay, bisexual, and other men who have sex with men (GBMSM) are highly stigmatized and male-male sex is often criminalized in sub-Saharan Africa, impeding access to quality care for sexual health, HIV prevention, and treatment. To better understand HIV care engagement and antiretroviral therapy (ART) adherence among GBMSM in this context, a conceptual model incorporating sociocultural factors is needed. We conducted a qualitative study of barriers to and facilitators of HIV care engagement and ART adherence among Kenyan GBMSM, informed by a conceptual model based on an access, information, motivation, and behavioral skills (access-IMB) model, with trust in providers and stigma and discrimination as a priori factors of interest. We conducted 30 semi-structured interviews with HIV-positive Kenyan GBMSM, of whom 20 were taking ART and 10 had not yet initiated treatment. A deductive approach was used to confirm the relevance of basic concepts of the access-IMB model, while an inductive approach was used to identify content that emerged from men's lived experiences. Access-related information, motivation, and behavioral skills appeared relevant to HIV care engagement and ART adherence, with stigma and discrimination appearing consistently across discourse exploring facilitators and barriers. Trusted providers and supportive family and friends helped many men, and resilience-related concepts such as selective disclosure of GBMSM status, connection to lesbian, gay, bisexual, and transgender (LGBT) organizations, self-acceptance, goal-setting, social identity and altruism emerged as important facilitators. Findings suggest a need to increase support from providers and peers for Kenyan GBMSM living with HIV infection. In addition, they point toward the potential value of interventions that provide opportunities to build or enhance one's sense of community belonging in order to improve HIV care engagement and promote ART adherence for this vulnerable population.