Intersecting stigma against MSM in clinical settings in Zambia

摘要 赞比亚是艾滋病毒感染率最高的10个国家之一（其中感染率约为12.3%）， 成年人）在世界上1，2，估计患病率为33%的男性与男性发生性关系（MSM）3。 尽管赞比亚政府最近将男男性行为者纳入其艾滋病毒预防议程， 由于同性恋行为的刑事化和持续的污名化，对男男性接触者的努力有限， 对男同性恋者的歧视2 - 4。对同性恋行为的污名往往与宗教信仰交织在一起。 艾滋病毒感染是对男男性接触者的神圣惩罚。与之相关的耻辱感的复合效应 多重边缘化身份（交叉污名）阻碍了男男性行为者获得艾滋病毒治疗 （诊断、与护理的联系、继续护理、开始抗逆转录病毒治疗、治疗依从性和病毒感染） 抑制）6、7.在临床环境中交叉污名的预期和经验进一步推动MSM 远离及时和高质量的艾滋病毒预防和护理服务8，9。虽然减少耻辱感 卫生保健提供者的干预措施已被确定为艾滋病毒预防和护理的优先事项 撒哈拉以南非洲男男性行为者议程8、10，赞比亚没有任何此类方案。研究审查 在法律的和法律的框架内， 赞比亚的文化背景极为有限。很少有现有的实证研究将交叉 男男性行为者参与艾滋病毒预防和护理的耻辱感，这对实现90 - 90 - 90 目标.此外，关于减少耻辱感的需求和有效战略的数据有限 在赞比亚进行临床干预。为了填补这些研究空白，我们的目标是进行混合方法 这项研究将：a）通过以下方式审查对男男性行为者交叉污名化的驱动因素/促进因素和表现形式： 政策审查和深入的定性访谈与男男性行为者和主要利益相关者; B）探讨的影响， 交叉的耻辱和潜在的机制，这种影响在临床环境中对男男性接触者的（不）参与， 通过对男男性行为者和医疗保健提供者的定量调查，确定艾滋病毒治疗的级联;以及c）确定 赞比亚临床环境中减少污名干预措施的需求和有效战略， 通过政策审查以及定性和定量研究收集的数据进行三角测量。初步数据 我们从这项研究中获得的经验将使我们能够制定一项医疗保健提供者干预措施， 减少临床环境中对男男性行为者的交叉污名，并改善其与艾滋病毒的联系 处理级联。

Abstract Zambia is one of the top 10 countries with the highest HIV prevalence rates (~12.3% prevalence rate among adults) in the world1,2, with an estimated prevalence rate of 33% among men who have sex with men (MSM)3. Although the Zambian government has recently included MSM in its HIV prevention agenda, intervention efforts for MSM are limited due to criminalization of homosexual behaviors and persistent stigma and discrimination against MSM2-4. Stigma against homosexual behaviors is often intertwined with the religious notion that HIV infection is divine punishment for MSM5. The compounded effect of stigma associated with multiple marginalized identities (intersecting stigma) impede MSM’s access to the HIV treatment cascade (diagnosis, linkage to care, retention in care, initiation of antiretroviral therapy, treatment adherence, and viral suppression)6,7. The anticipation and experience of intersecting stigma in clinical settings further drive MSM away from receiving timely and quality HIV prevention and care services8,9. Although stigma reduction interventions among healthcare providers have been identified as a priority in the HIV prevention and care agenda for MSM in Sub-Saharan Africa8,10, none of such programs is available in Zambia. Research examining the drivers, manifestations, and effects of intersecting stigma among healthcare providers in the legal and cultural context of Zambia is extremely limited. Very few existing empirical studies have linked intersecting stigma with MSM’s (dis)engagement in HIV prevention and care which is critical to achieve the 90-90-90 goals. In addition, limited data are available regarding the needs and efficacious strategies for stigma reduction intervention in clinical settings in Zambia. To fill in these research gaps, we aim to conduct a mixed-methods study that will: a) examine drivers/facilitators and manifestations of intersecting stigma against MSM through policy reviews and in-depth qualitative interviews with MSM and key stakeholders; b) explore the effects of intersecting stigma and potential mechanisms of such effects in clinical settings on MSM’s (dis)engagement in the HIV treatment cascade through quantitative surveys among MSM and healthcare providers; and c) identify the needs and effective strategies for stigma reduction interventions in clinical settings in Zambia based on triangulation of data collected via policy reviews and qualitative and quantitative studies. The preliminary data and experience we gain from this study will position us to develop a healthcare provider intervention that aims to reduce intersecting stigma against MSM in clinical settings and to improve their linkage to the HIV treatment cascade.