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

摘要 塞内加尔男男性行为者的艾滋病毒感染率为19%，而非洲为0.5%。 一般人口。大多数穆斯林（96%）对男男性行为者（MSM）的歧视很高 塞内加尔的国家。与艾滋病毒有关的污名源于社会文化和宗教信仰，认为艾滋病毒是一种惩罚 从上帝或罪恶行为的后果，包括婚姻和同性恋的界限外的性行为， 活动这些耻辱感可能是由于害怕轻蔑而脱离艾滋病毒护理的主要原因， 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。污名化和歧视性做法造成的孤立和恐惧可导致贫困， 寻求治疗的行为和对抗逆转录病毒治疗的依从性低。这反过来又可能导致 艾滋病症状困扰。尽管塞内加尔男男性行为者的艾滋病毒感染率极高，但在以下方面仍存在差距： 关于艾滋病毒和同性恋相关的交叉污名如何与 男同性恋人群中的艾滋病毒护理联系和保留。此外，尚不清楚是否存在 在这种情况下，艾滋病毒护理的联系和保留减少， 服务不足的人口。我们的长期目标是实施减少耻辱感的干预措施， 塞内加尔穆斯林社区的男男性行为者的艾滋病毒护理的连续性的联系。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，用于穆斯林背景下的男男性行为者。我们 将使用社区参与的方法来调整和测试塞内加尔穆斯林中男男性行为者的耻辱量表 社区.测试过程将包括表面效度和心理测量特性（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）。结果 将为未来的研究提供验证措施的证据。(Aim（2）评估关联 污名和行为（寻求治疗行为和依从性）之间的类型和交叉性 对250名城乡穆斯林男男性行为者LWH进行了调查， 塞内加尔的社区。我们假设，污名的水平和类型将与（1）治疗 （2）艾滋病患者的身心症状困扰程度较高。 我们还将研究所观察到的相关性是否部分或全部由与其他人的联系介导。 变量，包括因耻辱而避免披露。这项研究的结果将为以下方面奠定基础 设计干预措施，以帮助减轻污名对治疗相关行为的影响（联系 和继续接受护理），并随后改善大多数穆斯林中感染艾滋病毒的男男性行为者的健康结果 非洲国家

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.