"They are human beings, they are Swazi'': intersecting stigmas and the positive health, dignity and prevention needs of HIV-positive men who have sex with men in Swaziland
"They are human beings, they are Swazi'': intersecting stigmas and the positive health, dignity and prevention needs of HIV-positive men who have sex with men in Swaziland
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DOI：
10.7448/ias.16.4.18749
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发表时间：
2013-12-01
影响因子：
6
通讯作者：
Kerrigan, Deanna
中科院分区：
文献类型：
--
作者：
Kennedy, Caitlin E.;Baral, Stefan D.;Kerrigan, Deanna
简介：尽管人们知道男男性行为者 (MSM) 在不同环境下感染艾滋病毒的可能性更高，但对撒哈拉以南非洲地区感染艾滋病毒的男男性行为者的经历却很少进行调查。利用积极健康、尊严和预防的框架，我们探讨了斯威士兰艾滋病毒感染者 MSM 的经验和艾滋病毒预防、护理和治疗需求。 方法：我们对 20 名 HIV 阳性 MSM 进行了 40 次深度访谈，对关键知情人进行了 16 次访谈，并对 MSM 社区成员进行了 3 个焦点小组访谈。定性分析是迭代的，包括与研究人员进行汇报会、利益相关者研讨会以及使用 Atlas 进行关键主题编码。 ti.结果：主要主题是感染艾滋病毒的男男性接触者在这种情况下由于其性别认同和艾滋病毒状况而面临多种形式的重大耻辱和歧视。双重耻辱导致选择性披露或不披露两种身份，从而缺乏对寻求护理和药物依从性的社会支持。在医疗机构中感受到并经历过的耻辱，特别是在性别认同方面，也导致了寻求医疗服务的延迟、前往更远的诊所以及错失获得适当服务的机会。参与者描述了暴力和缺乏警察保护的经历以及心理健康挑战。然而，关键信息提供者反映了他们有责任向所有斯威士兰人提供非歧视性服务，无论个人信仰如何。结论：交叉性为理解斯威士兰艾滋病毒感染者男男性行为者所面临的双重耻辱和歧视的经历提供了一个框架，并强调了方案和政策在设计艾滋病毒预防、护理和治疗服务时应如何考虑该人群的具体需求。在斯威士兰，卫生部门应考虑为医疗保健提供者提供专门培训，分发避孕套和润滑剂，并让男男性行为者作为同行外展工作人员或专家客户。医护人员和普通民众还需要采取干预措施，减少针对男男性行为者和艾滋病毒感染者的耻辱、歧视和暴力。最后，对全球艾滋病毒感染者的经验和需求的研究可以帮助为该人群提供全面的艾滋病毒服务。
Introduction: Despite the knowledge that men who have sex with men (MSM) are more likely to be infected with HIV across settings, there has been little investigation of the experiences of MSM who are living with HIV in sub-Saharan Africa. Using the framework of positive health, dignity and prevention, we explored the experiences and HIV prevention, care and treatment needs of MSM who are living with HIV in Swaziland.Methods: We conducted 40 in-depth interviews with 20 HIV-positive MSM, 16 interviews with key informants and three focus groups with MSM community members. Qualitative analysis was iterative and included debriefing sessions with a study staff, a stakeholders' workshop and coding for key themes using Atlas. ti.Results: The predominant theme was the significant and multiple forms of stigma and discrimination faced by MSM living with HIV in this setting due to both their sexual identity and HIV status. Dual stigma led to selective disclosure or lack of disclosure of both identities, and consequently a lack of social support for care-seeking and medication adherence. Perceived and experienced stigma from healthcare settings, particularly around sexual identity, also led to delayed care-seeking, travel to more distant clinics and missed opportunities for appropriate services. Participants described experiences of violence and lack of police protection as well as mental health challenges. Key informants, however, reflected on their duty to provide non-discriminatory services to all Swazis regardless of personal beliefs.Conclusions: Intersectionality provides a framework for understanding the experiences of dual stigma and discrimination faced by MSM living with HIV in Swaziland and highlights how programmes and policies should consider the specific needs of this population when designing HIV prevention, care and treatment services. In Swaziland, the health sector should consider providing specialized training for healthcare providers, distributing condoms and lubricants and engaging MSM as peer outreach workers or expert clients. Interventions to reduce stigma, discrimination and violence against MSM and people living with HIV are also needed for both healthcare workers and the general population. Finally, research on experiences and needs of MSM living with HIV globally can help inform comprehensive HIV services for this population.