Addressing the Healthcare Needs of African Men who have Sex with Men: Barriers to Healthcare and Promoting HIV and STI Treatment in Sub-Saharan Africa.

Abstract

Barriers to healthcare for men who have sex with men (MSM) in sub-Saharan Africa (SSA) are rooted in stigma and discrimination against MSM fuelled by the criminalization of homosexuality. These barriers are influenced by factors involving MSM and the healthcare workers (HCWs). MSM are uncomfortable disclosing their identities and conceal symptoms of sexually transmitted infections (STIs), especially those in areas associated with homosexual behaviour to avoid stigmatization. MSM experience ill-treatment and abuse by HCWs and have concerns regarding HCWs maintaining confidentiality and privacy. This forces MSM to seek care from pharmacies/drugstores or resort to self-treatment, which may not be effective. This, coupled with increased HIV- and STI-risk behaviours resulting from depression and internalized homophobia, result in further spread of STIs. Further, barriers in HIV testing lead to exclusion of MSM from treatment cascades. Insufficient sexuality training of HCWs leads to discrimination or denial of treatment for MSM, particularly in government-run clinics. The criminalization of homosexuality deters HCWs from offering treatment to MSM. The prevailing discriminatory environment that accompanies the criminalization of homosexuality forces HCWs to don the role of moral and legal enforcers, making them the perpetrators of forced anal examinations that continue to be prevalent in SSA. Nevertheless, there is evidence to show HCWs in SSA recognize their lack of training in sexuality and have welcomed educational opportunities to better understand the healthcare needs of MSM. Pilot educational interventions for HCWs in SSA have been received enthusiastically, and have resulted in significant changes in HCW knowledge and attitudes and dealing with MSMs with STIs. This work reviews existing literature on barriers to STI-related healthcare for MSM in SSA. By drawing parallels to barriers that were overcome in the HIV epidemic in the 1980s, suitable solutions focusing on HCW education are suggested.