Open AccessSexual stigma and discrimination as barriers to seeking appropriate healthcare among men who have sex with men in Swaziland
Author(s) -
Risher Kathryn,
Adams Darrin,
Sithole Bhekie,
Ketende Sosthenes,
Kennedy Caitlin,
Mnisi Zandile,
Mabusa Xolile,
Baral Stefan D
Publication year - 2013
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.7448/ias.16.3.18715
Subject(s) - medicine , respondent , sexual orientation , stigma (botany) , men who have sex with men , logistic regression , health care , social stigma , demography , confidence interval , family medicine , psychiatry , clinical psychology , psychology , social psychology , syphilis , human immunodeficiency virus (hiv) , sociology , political science , law , economics , economic growth
Introduction Same‐sex practices and orientation are both stigmatized and criminalized in many countries across sub‐Saharan Africa. This study aimed to assess the relationship of fear of seeking healthcare and disclosure of same‐sex practices among a sample of men who have sex with men (MSM) in Swaziland with demographic, socio‐economic and behavioural determinants. Methods Three hundred and twenty‐three men who reported having had anal sex with a man in the past year were recruited using respondent‐driven sampling and administered a structured survey instrument. Asymptotically unbiased estimates of prevalence of stigma and human rights abuses generated using the RDSII estimator are reported with bootstrapped confidence intervals (CIs). Weighted simple and multiple logistic regressions of fear of seeking healthcare and disclosure of same‐sex practices to a healthcare provider with demographic, social and behavioural variables are reported. Results Stigma was common, including 61.7% (95% CI=54.0–69.0%) reporting fear of seeking healthcare, 44.1% (95% CI=36.2–51.3%) any enacted stigma and 73.9% (95% CI=67.7–80.1%) any perceived social stigma (family, friends). Ever disclosing sexual practices with other men to healthcare providers was low (25.6%, 95% CI=19.2–32.1%). In multiple logistic regression, fear of seeking healthcare was significantly associated with: having experienced legal discrimination as a result of sexual orientation or practice (aOR=1.9, 95% CI=1.1–3.4), having felt like you wanted to end your life (aOR=2.0, 95% CI=1.2–3.4), having been raped (aOR=11.0, 95% CI=1.4–84.4), finding it very difficult to insist on condom use when a male partner does not want to use a condom (aOR=2.1, 95% CI=1.0–4.1) and having a non‐Swazi nationality at birth (aOR=0.18, 95% CI=0.05–0.68). In multiple logistic regression, disclosure of same‐sex practices to a healthcare provider was significantly associated with: having completed secondary education or more (aOR=5.1, 95% CI=2.5–10.3), having used a condom with last casual male sexual partner (aOR=2.4, 95% CI=1.0–5.7) and having felt like you wanted to end your life (aOR=2.1, 95% CI=1.2–3.8). Conclusions MSM in Swaziland report high levels of stigma and discrimination. The observed associations can inform structural interventions to increase healthcare seeking and disclosure of sexual practices to healthcare workers, facilitating enhanced behavioural and biomedical HIV‐prevention approaches among MSM in Swaziland.