Assessing stigma, care seeking, and treatment adherence of MSM living with HIV in Senegalese Muslim communities

评估塞内加尔穆斯林社区中感染艾滋病毒的 MSM 的耻辱感、寻求护理和治疗依从性

• 批准号: 9914146
• 负责人: PAULA AMINA ALIO
• 金额: $ 16.91万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9914146
• 关键词: Address; Adherence; African; Anthropology; Behavior; Behavior Therapy; Caring; Clinical; Clinical Trials; Communities; Country; Critical Care; Disclosure; Discrimination; Distress; Epidemiology; Evaluation; Face; Factor Analysis; Feedback; Fright; Future; General Population; Goals; HIV; HIV Seropositivity; Health; Health Services Accessibility; Heterosexuals; Homophobia; Homosexuality; Homosexuals; Human immunodeficiency virus test; Individual; Intervention; Knowledge; Lead; Link; Marriage; Measures; Mediating; Muslim population group; Outcome; Population; Prevalence; Process; Property; Psyche structure; Psychiatry; Psychology; Psychometrics; Public Health; Punishment; Qualitative Methods; Religion and Spirituality; Religious Belief; Research; Risk; Rural; Sampling; Senegal; Solid; Stigmatization; Surveys; Symptoms; Target Populations; Testing; Underserved Population; Validity and Reliability; antiretroviral therapy; base; behavioral adherence; behavioral health; care seeking; cost; data management; experience; female sex worker; improved; innovation; insight; intersectionality; maltreatment; men who have sex with men; mortality risk; physical symptom; psychological symptom; public health relevance; recruit; sex; social culture; social stigma; stem; symptom management; symptomatic improvement; therapy design; therapy development; treatment adherence

ABSTRACT HIV prevalence among men who have sex with men (MSM) in Senegal is 19%, compared with 0.5% in the general population. Stigma against men who have sex with men (MSM) is high in the majority (96%) Muslim country of Senegal. HIV-related stigma stems from sociocultural and religious beliefs that HIV is a punishment from God or the consequence of sinful behaviors, including sex outside the bounds of marriage and homosexual activity. These stigmas can be major contributors to disengagement from HIV care for fear of scorn and mistreatment. Linkage to and retention in HIV care are critical for improving symptom management and reducing risk of mortality. Isolation and fear resulting from stigma and discriminatory practices can lead to poor treatment seeking behaviors and low adherence to antiretroviral therapy. This in turn may result in increases in HIV symptom distress. Despite the extremely high HIV prevalence in MSM in Senegal, there are gaps in scientific knowledge regarding how intersecting HIV- and homosexuality-related stigmas are associated with HIV care linkage and retention in the MSM population. Further, it is unknown if associations between stigmas and health outcomes are mediated by decreased linkage and retention in HIV care in this underserved population. Our long-term goal is to implement stigma-reduction interventions in order to increase linkage to the continuum of HIV care for MSM in Muslim communities in Senegal. To this end, we will: (Aim 1) Adapt and assess the validity and reliability of stigma scales for use among MSM in the Muslim context. We will use a community-engaged approach to adapt and test stigma scales among MSM in Senegalese Muslim communities. Testing processes will consist of face validity and psychometric properties (including correlation matrices, split-half reliability, criterion validity, and both exploratory and confirmatory factor analysis). Findings will provide evidence of validated measures for use in future studies. (Aim 2) Assess the association between the types of and intersectionality between stigmas, and behavioral (treatment seeking behaviors and adherence to treatment) and symptom distress (mental and physical) among 250 MSM LWH in urban and rural Muslim communities in Senegal. We hypothesize that level and type of stigma will be associated with (1) treatment avoidance and low adherence to treatment; and (2) higher HIV physical and psychological symptom distress. We will also examine whether the observed correlations are partially or fully mediated by association with other variables, including disclosure avoidance due to stigma. Findings from this study will lay the groundwork for the design of an intervention to help mitigate the impact of stigmas on treatment related behaviors (linkage and retention in care) and subsequently improve health outcomes of MSM living with HIV in majority Muslim African countries.

摘要 塞内加尔男男性行为者(MSM)中艾滋病毒感染率为19%，而塞内加尔为0.5% 普通人口。在大多数穆斯林(96%)中，对男男性行为者(MSM)的耻辱很高 塞内加尔的一个国家。与艾滋病毒有关的耻辱源于社会文化和宗教信仰，即艾滋病毒是一种惩罚 来自上帝或罪恶行为的后果，包括婚姻和同性恋以外的性行为 活动。这些耻辱可能是导致脱离艾滋病毒护理的主要原因，因为他们担心受到蔑视和 虐待。与艾滋病毒护理的联系和保留对于改善症状管理和 降低死亡风险。耻辱和歧视性做法造成的孤立和恐惧可能会导致贫穷 寻求治疗行为和对抗逆转录病毒治疗的依从性低。这反过来可能会导致 HIV症状困扰。尽管塞内加尔男男性接触者中艾滋病毒感染率极高，但在以下方面存在差距 关于艾滋病毒和同性恋相关的污名是如何与 男男性接触者人群中的艾滋病毒护理联系和保留。此外，尚不清楚两者之间的联系 耻辱和健康结果是通过减少艾滋病毒护理中的联系和保留而起作用的 服务不足的人口。我们的长期目标是实施减少耻辱的干预措施，以增加 与塞内加尔穆斯林社区男男性接触者艾滋病毒护理的连续性联系。为此，我们将：(目标1) 调整和评估污名量表的有效性和可靠性，以便在穆斯林背景下的男男性接触者中使用。我们 将使用社区参与的方法来适应和测试塞内加尔穆斯林MSM中的污名量表 社区。测试过程将包括面孔效度和心理测量学特性(包括相关性 矩阵、分半信度、标准效度，以及探索性和验证性因素分析)。发现 将为未来研究中使用的有效措施提供证据。(目标2)评估 柱头的类型和交叉性，以及行为(寻求治疗的行为和坚持 250名城市和农村穆斯林男男性接触者LWH的精神和躯体症状困扰 塞内加尔的社区。我们假设耻辱的程度和类型将与(1)治疗有关 回避和对治疗的低依从性；以及(2)较高的HIV生理和心理症状苦恼。 我们还将研究观察到的相关性是否部分或完全通过与其他 变数，包括因耻辱而避免披露。这项研究的发现将为 旨在帮助减轻耻辱对治疗相关行为的影响的干预措施的设计(联系 并随后改善穆斯林占多数的MSM艾滋病毒携带者的健康结局 非洲国家。

项目成果

They call us goor-jigeen: a qualitative exploration of the experiences of Senegalese Muslim men who have sex with men living with HIV.

他们称我们为“goor-jigeen”：对与艾滋病毒感染者发生性关系的塞内加尔穆斯林男性的经历进行定性探索。

• DOI: 10.1080/13691058.2022.2080273
• 发表时间: 2022
• 期刊: Culture, health & sexuality
• 作者: Alio,AminaP;Khoudia,Abdou;Thiam,MamadouH;Talawa,DrusillaA;Bamfonga,Gradi;AlAnsar,Abdoulaye;Ndour,CheikhT;Ndoye,Omar
• 通讯作者: Ndoye,Omar