142nd APHA Annual Meeting and Exposition

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312429
Effect of Stigma, Discrimination and Alienation on the HIV Treatment Cascade for Cameroonian MSM

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Charles W. Cange, PhD, MSc , Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD
Stef Baral, MD, MPH, MBA , Johns Hopkins School of Public Health, Baltimore, MD
Erin Papworth, MPH , Johns Hopkins School of Public Health, Baltimore, MD
Karen Saylors, PhD , Metabiota, San Francisco, CA
Matthew LeBreton, BSc , Metabiota, Yaounde, Cameroon
Ubald Tamoufe , Metabiota, Yaounde, Cameroon
Background: Men who have sex with men in Cameroon consistently face significant stigma and discrimination. The urban HIV prevalence in MSM is estimated at 35% with limited provision and uptake of specific HIV care. This study investigates the effect of stigma, discrimination and alienation on Cameroonian MSM's engagement of the HIV treatment cascade.

Methods: Key informants interviews with allies, in-depth interviews with MSM, and focus groups with MSM were used. Participants in 6 cities were asked to describe the MSM social and structural context, MSM knowledge of existing HIV-related services in clinics, MSM-specific services and how to improve services. 
Using a codebook, coded texts were analyzed for recurring themes that were developed into results.

Results: First, many MSM reported experiences of discrimination, bribery and physical violence outside the health care setting. In addition, they recounted instances of community-level stigma regarding same-sex practices. 

Second, we investigated the MSM-specific HIV/AIDS services. Most participants observed limited clinical and cultural competency of clinic staff in addressing their needs. 

Thirdly, MSM declared that there was a significant psychological toll on them due to the lack of social support and limited healthcare access. Several individuals recounted feelings of alienation and depression; their alienation greatly discouraged them from seeking HIV services.

Conclusions: Community-level and healthcare-related stigma impacts the mental well-being of Cameroonian MSM as well as the uptake of MSM-oriented HIV/AIDS services. These data suggest an MSM-sensitization, stigma-reduction intervention for Cameroonian health care and social workers. This intervention may increase the uptake of HIV services for Cameroonian MSM.

Learning Areas:

Advocacy for health and health education
Diversity and culture
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Social and behavioral sciences

Learning Objectives:
Identify the effects of stigma, discrimination and alienation on the HIV treatment cascade for Cameroonian MSM

Keyword(s): Marginalization, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For this Cameroon-specific project, I conceived and organized the paper topic as well as performed the data analysis. Among my scientific interests, I have been active in the development of strategies for reporting on and mitigating HIV and MSM stigma in global health settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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