Abstract
Abstract Background Criminalization of same-sex relations is a driver of the HIV epidemic. Whilst LGBT activists advocate for social change in sub-Saharan Africa, men who engage in same-sex relations -many of which have sex with women (MSM/W)- face obstacles in all steps of the HIV cascade of care. In Senegal, research on MSM/W has been authorized given their assigned status as a key population in the fight against HIV. In 2018-19, a grounded theory research was done with the aim to understand the health experiences of MSM/W in Dakar. Methods Individual interviews were conducted with 19 MSM/W. Respondents were recruited with the aid of local grassroots. A non-structured life story guide was used to help them recall in chronological order their experiences with healthcare. Results No major constraints in using HIV services were expressed. There were narratives of self-hatred, internalized homophobia, emotional stress, sleep disorders, and low self-esteem. A few mentioned suicidal thoughts. Histories of sexual abuse, and feelings of sexual orientation being passed on by the perpetrators were common. Fear of hatred and violence caused some respondents to pursue heterosexual relationships, and, in a few cases, to resort to spiritual healers to change their sexual identity. In spite of religion being identified as a fueler of stigmatization, many found relief in practicing Islam. Conclusions Findings informed a Training Program on MSM/W Psychosocial Health, which will target 100 healthcare workers in 2020. This study shows that psychosocial health for MSM/W needs to be promoted not just as a component in the Zero HIV Transmission for 2030 efforts. It is time to move from an HIV Care for All MSM to a Wellbeing for All MSM paradigm. Further research on same-sex identities as determinants of diseases other than HIV is needed. Human rights should be at the fore of efforts to build capacities to tackle the psychosocial needs of all MSM/W in Senegal.
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