Autonomy-Supportive Healthcare Climate and HIV-Related Stigma Predict Linkage to HIV Care in Men Who Have Sex With Men in Ghana, West Africa

Author:

Gu Lily Y.1ORCID,Zhang Nanhua23,Mayer Kenneth H.4,McMahon James M.5,Nam Soohyun6,Conserve Donaldson F.7,Moskow Marian5,Brasch Judith5,Adu-Sarkodie Yaw8,Agyarko-Poku Thomas8,Boakye Francis9,Nelson LaRon E.6101112ORCID

Affiliation:

1. School of Medicine, University of Utah, Salt Lake City, UT, USA

2. Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH, USA

3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

4. Fenway Institute, Fenway Health, Boston MA, USA

5. School of Nursing, University of Rochester, Rochester, NY, USA

6. School of Nursing, Yale University, New Haven, CT, USA

7. Milken Institute School of Public Health, George Washington University, Washington DC, USA

8. School of Medical Sciences, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana

9. Priorities on Rights & Sexual Health, Accra, Ghana

10. Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA

11. Yale Institute of Global Health, Yale University, New Haven, CT, USA

12. MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada

Abstract

In Ghana, the HIV prevalence among MSM is more than 10 times greater than the general population of adults, and rates of engagement in HIV medical care are low among MSM diagnosed with HIV. Using structured surveys, we investigated the impact of HIV-related stigma, same-sex behavior stigma, and gender nonconformity stigma on linkage to HIV care (LTC) in MSM ( N = 225) living with HIV in Ghana. Autonomy-supportive healthcare climate ( OR = 1.63, p < .01), vicarious HIV stigma ( OR = 2.73, p < .01), and age ( OR = 1.06, p < .004) predicted LTC. Conversely, felt normative HIV stigma negatively predicted LTC ( OR = 0.65, p < .05). Finally, we identified regional disparities, with MSM from Takoradi being 4 times and 5 times more likely to be LTC compared to Kumasi and Accra, respectively. Our findings highlight the nuanced roles of stigmas in shaping the HIV care continuum among MSM living with HIV, while revealing potential gaps in current measures of HIV-related stigma.

Funder

National Institute of Mental Health

Publisher

SAGE Publications

Subject

Infectious Diseases,Dermatology,Immunology

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