Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries

John Mark Wiginton, Sarah M. Murray, Ohemaa Poku, Jura Augustinavicius, Kevon Mark Phillip Jackman, Jeremy Kane, Serge C. Billong, Daouda Diouf, Ibrahima Ba, Tampose Mothopeng, Iliassou Mfochive Njindam, Gnilane Turpin, Ubald Tamoufe, Bhekie Sithole, Maria Zlotorzynska, Travis H. Sanchez, Stefan D. Baral

Research output: Contribution to journalArticlepeer-review

Abstract

Background: For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. Methods: We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d’Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. Results: Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. Conclusions: Research to determine the factors driving disclosure’s differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.

Original languageEnglish (US)
Article number2206
JournalBMC public health
Volume21
Issue number1
DOIs
StatePublished - Dec 2021
Externally publishedYes

Keywords

  • Disclosure
  • Healthcare stigma
  • Men who have sex with men
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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