Abstract
ABSTRACTGay, bisexual, and other men who have sex with men (GBMSM) are highly stigmatized and male–male sex is often criminalized in sub-Saharan Africa, impeding access to quality care for sexual health, HIV prevention, and treatment. To better understand HIV care engagement and antiretroviral therapy (ART) adherence among GBMSM in this context, a conceptual model incorporating sociocultural factors is needed. We conducted a qualitative study of barriers to and facilitators of HIV care engagement and ART adherence among Kenyan GBMSM, informed by a conceptual model based on an access, information, motivation, and behavioral skills (access-IMB) model, with trust in providers and stigma and discrimination as a priori factors of interest. We conducted 30 semi-structured interviews with HIV-positive Kenyan GBMSM, of whom 20 were taking ART and 10 had not yet initiated treatment. A deductive approach was used to confirm the relevance of basic concepts of the access-IMB model, while an inductive approach was used to identify content that emerged from men’s lived experiences. Access-related information, motivation, and behavioral skills appeared relevant to HIV care engagement and ART adherence, with stigma and discrimination appearing consistently across discourse exploring facilitators and barriers. Trusted providers and supportive family and friends helped many men, and resilience-related concepts such as selective disclosure of GBMSM status, connection to lesbian, gay, bisexual, and transgender (LGBT) organizations, self-acceptance, goal-setting, social identity and altruism emerged as important facilitators. Findings suggest a need to increase support from providers and peers for Kenyan GBMSM living with HIV infection. In addition, they point toward the potential value of interventions that provide opportunities to build or enhance one’s sense of community belonging in order to improve HIV care engagement and promote ART adherence for this vulnerable population.
Highlights
Gay, bisexual, and other men who have sex with men (GBMSM) are a marginalized group in sub-Saharan Africa, with a disproportionately high HIV prevalence relative to men in the general population (Smith, Tapsoba, Peshu, Sanders, & Jaffe, 2009; Beyrer et al, 2012)
Greater exposure to health services may result in more adverse experiences; for example, in a survey of GBMSM living in Malawi, Namibia, and Botswana, being treated for HIV was associated with a greater odds of fearing to seek health care services, ever having been denied services on the basis of sexuality, and having been blackmailed due to sexuality (Fay et al, 2011)
In the present qualitative study, we aimed to identify barriers and facilitators of HIV care engagement and antiretroviral therapy (ART) adherence among Kenyan GBMSM and inform the development of a more complex and tailored conceptual model, as part of a larger study of an ART adherence support intervention for Kenyan GBMSM living with HIV infection
Summary
Bisexual, and other men who have sex with men (GBMSM) are a marginalized group in sub-Saharan Africa, with a disproportionately high HIV prevalence relative to men in the general population (Smith, Tapsoba, Peshu, Sanders, & Jaffe, 2009; Beyrer et al, 2012). Cloete et al reported that HIV-positive GBMSM in South Africa experienced higher levels of discrimination than did HIV-positive heterosexual men (Cloete, Simbayi, Kalichman, Strebel, & Henda, 2008). Greater exposure to health services may result in more adverse experiences; for example, in a survey of GBMSM living in Malawi, Namibia, and Botswana, being treated for HIV was associated with a greater odds of fearing to seek health care services, ever having been denied services on the basis of sexuality, and having been blackmailed due to sexuality (Fay et al, 2011).
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